Approach

Actinomycosis is usually diagnosed after surgery for treatment of an abscess or tumour. High-dose, prolonged systemic antibiotic treatment is necessary, sometimes in combination with surgery.[48][49][50][51][52][53][54]​ With this approach, the outcome is favourable in more than 90% of cases.[1] Relapse is rare after sufficient antibiotic treatment. If it occurs, it is treated in the same way as a primary infection.

Management and antibiotic treatment

High-dose penicillin is the preferred choice, given intravenously for 4 to 6 weeks, followed by oral therapy for a further 3 to 6 months. Intravenous therapy can be given on an inpatient or outpatient basis, depending on the severity of disease.[1][11][51]

For patients who are allergic to penicillin, parenteral ceftriaxone, clindamycin, erythromycin, or doxycycline can be used.[48][53][54][55][56] Patients with mild cervicofacial actinomycosis of endodontic origin may be given oral doxycycline from the outset.

Consultation with an expert in microbiology or infectious diseases is recommended.[7] ​Intrauterine devices should be removed from patients with pelvic or abdominal actinomycosis.[7][57]

Excision of lesions

Surgery should be reserved for excision of lesions in patients with extensive lesions, extensive necrosis, or large abscess formation.[7]​ Sometimes persistent fistulae must be removed by surgery. In patients in whom a malignant process cannot be ruled out, surgery may also be necessary for final diagnosis and treatment planning.[58]

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