Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

non-penicillin allergic

1st line – penicillin or amoxicillin

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ACUTE
|
non-penicillin allergic
1st line – 

penicillin or amoxicillin

Prolonged high-dose antibiotic therapy with a penicillin is the preferred treatment. Given parenterally for 4 to 6 weeks, followed by oral therapy for a further 3 to 6 months. Parenteral therapy can be given on an inpatient or outpatient basis, depending on severity of disease.[1][11][51][59]​ Consultation with an expert in microbiology or infectious diseases is recommended.[7]

Primary options

penicillin G potassium: 10-20 million units/day intravenously/intramuscularly given in divided doses every 4-6 hours for 4-6 weeks

and

penicillin V potassium: 2-4 g/day orally given in 4-6 divided doses for 3-6 months after cessation of intravenous therapy

OR

ampicillin: 50 mg/kg/day intravenously given in divided doses every 8 hours for 4-6 weeks

and

amoxicillin: 500 mg orally three times daily for 3-6 months after cessation of intravenous therapy

Consider – intrauterine device removal

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ACUTE
|
non-penicillin allergic
|
non-penicillin allergic
Consider – 

intrauterine device removal

Treatment recommended for SOME patients in selected patient group

Intrauterine devices should be removed from patients with pelvic or abdominal actinomycosis.[7][57]

Plus – surgical excision of lesions

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ACUTE
|
non-penicillin allergic
|
with extensive lesions, extensive necrosis, large abscess formation, and/or persistent fistula
Plus – 

surgical excision of lesions

Treatment recommended for ALL patients in selected patient group

These patients may require surgery to excise the lesions in addition to antibiotics.[58]​​

penicillin allergic

1st line – non-penicillin antibiotics

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ACUTE
|
penicillin allergic
1st line – 

non-penicillin antibiotics

Ceftriaxone, clindamycin, erythromycin, or doxycycline can be used. Therapy needs to be given for several months. Most regimens involve an initial period of parenteral therapy, which can be given on an inpatient or outpatient basis, depending on severity of disease.[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]​​​​

Primary options

ceftriaxone: 2 g intravenously/intramuscularly every 12-24 hours for 4-6 weeks

and

doxycycline: 100 mg orally twice daily for 3-6 months after cessation of intravenous therapy

OR

erythromycin lactobionate: 500 mg intravenously every 6 hours for 4-6 weeks

and

erythromycin base: 500 mg orally twice daily for 3-6 months after cessation of intravenous therapy

OR

doxycycline: 100 mg twice daily orally for 4-6 months

Consider – intrauterine device removal

Back
ACUTE
|
penicillin allergic
|
penicillin allergic
Consider – 

intrauterine device removal

Treatment recommended for SOME patients in selected patient group

Intrauterine devices should be removed from patients with pelvic or abdominal actinomycosis.[7][57]​​

Plus – surgical excision of lesions

Back
ACUTE
|
penicillin allergic
|
with extensive lesions, extensive necrosis, large abscess formation, and/or persistent fistula
Plus – 

surgical excision of lesions

Treatment recommended for ALL patients in selected patient group

These patients may require surgery to excise the lesions in addition to antibiotics.[58]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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