Materiały źródłowe

• #1 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4094581/

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. […] The cornerstone of treatment is prolonged antimicrobial therapy with a beta-lactam such as penicillin or amoxicillin. […] Surgical management can be required for drainage of voluminous abscesses, marsupialization of chronic sinus tracts, excision of recalcitrant fibrotic lesion, and/or debridement of necrotic bone tissue in case of osteomyelitis.

• #2 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. […] The cornerstone of treatment is prolonged antimicrobial therapy with a beta-lactam such as penicillin or amoxicillin. […] Surgical management can be required for drainage of voluminous abscesses, marsupialization of chronic sinus tracts, excision of recalcitrant fibrotic lesion, and/or debridement of necrotic bone tissue in case of osteomyelitis.

• #3 Actinomycosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24981-actinomycosis

  Providers treat it with high doses of antibiotics over several months. […] Healthcare providers treat actinomycosis with high doses of antibiotics. A provider usually gives you antibiotics through an IV in your arm for a few days or weeks, then you continue to take an antibiotic in pill form at home. They may also need to drain infected areas and remove dead tissue from them (debridement). […] A provider might use one of the following antibiotics to treat actinomycosis: Penicillin, Amoxicillin, Erythromycin, Tetracycline, Doxycycline, Minocycline, Clindamycin. […] You may need to take antibiotics for months or even a year for actinomycosis to completely go away. If you stop antibiotics too soon, the infection can come back or start spreading again. […] The best way to take care of yourself with actinomycosis is to take all of your medication as prescribed and keep all follow-up appointments with your provider. If you stop taking antibiotics too soon, the infection can spread again and cause serious complications. […] With early diagnosis and treatment, you can cure actinomycosis. Treatment can take a long time and requires patience. Be sure to check in with your healthcare provider frequently. They can make sure you’re on the right antibiotics and let you know when it’s safe to stop treatment.

• #4 Treatment of actinomycosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-actinomycosis

  Treatment of actinomycosis […] Management of actinomycosis often entails prolonged courses of antimicrobials. Surgical intervention may also be necessary in more complicated cases, such as infection in critical spaces (eg, epidural infections, brain abscesses), patients with massive hemoptysis, or when extensive abscesses and fistulous tracts are present. […] The treatment of actinomycosis will be discussed here. […] Preferred regimens — We generally suggest high-dose penicillin for actinomycosis. Reasonable alternatives include ceftriaxone and amoxicillin. The route of administration depends on the severity of infection: […] Severe or extensive actinomycosis – Severe, extensive infection is often invasive and associated with significant purulence or fistulous tracts, and often occurs in patients with significant underlying comorbidities. For severe infection, we recommend an initial course of intravenous penicillin G (10 to 20 million units daily in divided doses every four to six hours). In the outpatient setting, administering penicillin G as a continuous infusion may make dosing less cumbersome. Ceftriaxone (1 to 2 g every 24 hours) is a reasonable alternative that can also be more easily administered for treatment in the outpatient setting. Surgery is also warranted in certain severe cases.

• #5 Actinomycosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/211587-treatment

  In most cases of actinomycosis, antimicrobial therapy is the only treatment required, although surgery can be adjunctive in selected cases. Penicillin G is the drug of choice for treating infections caused by actinomycetes. […] Parenteral antibiotics are administered initially via PICC line, with transition to oral agents. […] Attempt to cure actinomycosis, including extensive disease, with aggressive antimicrobial therapy alone initially. Surgical therapy may include incision and drainage of abscesses, excision of sinus tracts and recalcitrant fibrotic lesions, decompression of closed-space infections, and interventions aimed at relieving obstruction (eg, when actinomycotic lesions compress the ureter). […] Follow up on outpatient intravenous antibiotic programs and switch patients to oral antibiotic therapy. Prolonged antibiotic therapy is often required. […] If penicillin therapy is failing, consider broadening the antimicrobial spectrum to cover the potentially uncultured companion bacteria.

• #6 Treatment of actinomycosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-actinomycosis/print

  Treatment of actinomycosis […] Management of actinomycosis often entails prolonged courses of antimicrobials. Surgical intervention may also be necessary in more complicated cases, such as infection in critical spaces (eg, epidural infections, brain abscesses), patients with massive hemoptysis, or when extensive abscesses and fistulous tracts are present. […] The treatment of actinomycosis will be discussed here. […] Preferred regimens — We generally suggest high-dose penicillin for actinomycosis. Reasonable alternatives include ceftriaxone and amoxicillin. The route of administration depends on the severity of infection: […] For severe infection, we recommend an initial course of intravenous penicillin G (10 to 20 million units daily in divided doses every four to six hours). […] Initial parenteral therapy is typically given for four to six weeks. Switching from intravenous to oral therapy is usually possible after there is significant improvement in the patient’s condition, which typically happens within this time frame. The parenteral regimen is followed by oral penicillin V (2 to 4 g per day, divided into four daily doses). Oral amoxicillin is probably equally efficacious.

• #7 Treatment of actinomycosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-actinomycosis

  Initial parenteral therapy is typically given for four to six weeks. Switching from intravenous to oral therapy is usually possible after there is significant improvement in the patient’s condition, which typically happens within this time frame. The parenteral regimen is followed by oral penicillin V (2 to 4 g per day, divided into four daily doses). Oral amoxicillin is probably equally efficacious. Data informing the optimal dose of amoxicillin are limited, but we generally use 1.5 to 3 g per day, divided into three or four daily doses. For all the antibiotic regimens, we use a dose at the higher end of the range for more serious infections.

• #8 Actinomyces | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540005/all/Actinomyces

  Preferred: […] Penicillin G 18-24mil units IV/d x 2-6 wks, then amoxicillin 500-750mg PO three times a day/four times a day x 6-12 mos until sufficient resolution. […] Oral therapy alone may be adequate; no high-quality trials exist to compare treatment approaches or duration. […] The need to treat co-pathogens is unclear. […] […] Alternatives: […] Doxycycline 100mg twice daily IV x 2-6 wks if not able to take orals, then 100mg PO twice daily x 6-12mos. […] Erythromycin 500mg PO four times a day x 6-12 mos. […] Other agents (limited data): clarithromycin, azithromycin, imipenem, cefotaxime, piperacillin/tazobactam, clindamycin, and ceftriaxone. […] Many clinicians use ceftriaxone for once-daily convenience; however, with C. difficile risks, PCN G may be preferred. […]

• #9 Actinomycosis Medication: Antibiotics

  https://emedicine.medscape.com/article/211587-medication

  High-dose penicillin administered over a prolonged period (6 months to 1 year) is the cornerstone of therapy for actinomycosis. […] Success with shorter courses of therapy ( 6 mo) has been reported, especially in cervicofacial actinomycosis. […] Ultimately, the treatment duration should be tailored to the individual patient based on clinical and radiographic response. Patients should be monitored more closely if shorter treatment durations are considered. […] The risk of actinomycetes developing penicillin resistance appears to be minimal. Lack of a clinical response to penicillin usually indicates the presence of resistant companion bacteria, which may require modification of the antibiotic regimen (ie, addition of an agent that is active against these copathogens). […] Antibiotics that possess no activity against Actinomyces species include metronidazole, aminoglycosides, aztreonam, co-trimoxazole (TMP-SMX), penicillinase-resistant penicillins (eg, methicillin, nafcillin, oxacillin, cloxacillin), and cephalexin.

• #10 SciELO Brazil – Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

  https://www.scielo.br/j/bjid/a/GVf6pS8FvyjTvVSWMspjbrQ/?lang=en

  Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital. […] Here we present three cases in which intramuscular (IM) ceftriaxone was successfully used in the outpatient settings following IV penicillin treatment in the hospital. […] Considering the data in the literature on successful therapy of actinomycosis with ceftriaxone this drug may be a good candidate for outpatient approach because it can be administered intramuscularly once in a day. […] In conclusion daily IM ceftriaxone therapy can facilitate outpatient management of pelvic actinomycosis.

• #11 Actinomycosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/actinomycosis

  Most patients with actinomycosis respond to antibiotics, but response is usually slow because of extensive tissue induration and the relatively avascular nature of the lesions. Therefore, treatment must be continued for at least 8 weeks and occasionally for 1 year, until symptoms and signs have resolved. […] High doses of penicillin G (eg, 3 to 5 million units IV every 6 hours) are usually effective. Penicillin V 1 g orally 4 times a day may be substituted after about 2 to 6 weeks. Oral tetracycline 500 mg every 6 hours or doxycycline 100 mg every 12 hours may be given instead of penicillin. Minocycline, clindamycin, and erythromycin have also been successful. Antibiotic regimens may be broadened to cover other pathogens cultured from lesions. […] Treatment of IUD-associated pelvic actinomycosis also involves removal of the IUD. Extensive pelvic disease may require drainage of intra-abdominal abscesses, sometimes with hysterectomy and salpingo-oophorectomy.

• #12 Actinomycosis

  https://dermnetnz.org/topics/actinomycosis

  The goal of actinomycosis treatment is to treat the infection with large doses of antibiotics and surgery to create unfavourable aerobic conditions for the growth of Actinomyces species. […] Actinomycosis is treated with antibiotics, such as penicillin. High doses of intravenous penicillin followed by oral penicillin is usually needed to penetrate areas of fibrosis and suppuration. Prolonged treatment is often required to prevent relapse. […] Alternative antibiotics include tetracyclines, erythromycin, and clindamycin. […] Surgical management includes drainage of deep abscesses, excision of sinus tracts and removal of bulky infected masses. […] Combination treatment of penicillin and surgery nearly always produces a cure.

• #13 Actinomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482151/

  Actinomycosis is generally not diagnosed until the chronic phase. In otherwise healthy individuals, the infection is generally treatable with a prolonged course of intravenous antibiotics; the outcome is more nebulous for immunocompromised individuals. This activity reviews the evaluation and treatment of actinomycosis and highlights the role of the interprofessional team in caring for patients with this condition. […] Most of the cases can be managed with antibiotics; surgery can be adjunctive. Medical management in the form of antibiotics includes: Penicillin G, Beta-lactams with a long course of oral amoxicillin, Cephalosporin. If the patient is allergic to penicillin, alternatives include: Clindamycin, Macrolides (erythromycin, clarithromycin or azithromycin), Doxycycline. A combination of metronidazole and a beta-lactamase inhibitor may be tried in polymicrobial infections.

• #14 Diagnosis and Management of Cervicofacial Actinomycosis: Lessons from Two Distinct Clinical Cases

  https://www.mdpi.com/2079-6382/9/4/139

  Alternatively, clindamycin (owing to its good tissue penetration) is also a viable first-line option for therapy. […] In case of a polymicrobial infection, metronidazole (against other anaerobes), β-lactam/β-lactamase-inhibitor combinations or carbapenems, aminoglycosides (e.g., for Enterobacteriaceae) should be considered in the therapeutic regimen. […] Nevertheless, more recent reports indicate that long-term antibiotic-therapy (especially in mild cases) may not even be necessary, as there was no significant difference observed in the clinical outcomes associated with the therapies of different duration.

• #15 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/actinomycosis-2/

  2. Alternatives (e.g. for allergic patients) include erythromycin, tetracycline and clindamycin. Less compelling evidence (case reports) exist for broad spectrum beta-lactams such as ceftriaxone, piperacillin-tazobactam and carbapenems. […] […] 3. Drugs to be avoided include the anti-staphylococcal penicillins, oral first generation cephalosporins and metronidazole. Since aminoglycosides require aerobic bacterial metabolism to work and are toxic when given over long periods, this class should be completely avoided. […] […] 4. Little clinical evidence is available for some agents that have good in vitro activity and might be used as alternatives. This list includes linezolid, azithromycin, vancomycin and fluoroquinolones with strong gram-positive/anaerobic activity such as moxifloxacin. […]

• #16 Actinomycosis – MD Searchlight

  https://mdsearchlight.com/infectious-disease/actinomycosis/

  Most cases of this condition can be treated using antibiotics, and sometimes, surgery may be used as an additional treatment. Often, the following antibiotics are prescribed: Penicillin G, Long-lasting beta-lactam antibiotics followed by oral amoxicillin, Cephalosporin. […] If you’re allergic to penicillin, there are alternative medications available including: Clindamycin, Macrolides (like erythromycin, clarithromycin, or azithromycin), Doxycycline. […] For infections caused by multiple types of bacteria, a combination of metronidazole and a beta-lactamase inhibitor might be used. There’s no need for antimicrobial susceptibility testing because the antibiotic resistance patterns are predictable. […] Treatment usually lasts 6 to 12 months, but it could be cut short if the patient undergoes surgery to remove the infected area. The specific type of surgery depends on the location and severity of the disease. It often involves making an incision to drain abscesses, decompressing a closed space, and removing sinus tracts (abnormal tunnels connecting tissues). […] Doctors use imaging techniques to monitor how well the treatment is working.

• #17 Actinomyces | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540005/all/Actinomyces

  Not active: metronidazole, TMP/SMX, ceftazidime, aminoglycosides, oxacillin, fluoroquinolones. […] Response to appropriate antibiotic therapy is usually slow; very long courses are required to achieve resolution and prevent relapse. […] […] Surgery: usually reserved for suspected neoplasm, to establish a diagnosis, lesion in a vital area (epidural, CNS, etc.), large mass or unresponsiveness to treatment. […] Surgical procedures: debulking, excision of fistula tracts, abscess drainage.

• #18 Thoracic actinomycosis – EMCrit Project

  https://emcrit.org/ibcc/actinomycosis/

  Treatment duration: Prolonged therapy may be needed for severe disease (e.g., ~2-6 weeks of intravenous therapy followed by 6-12 months of oral treatment). However, the duration of IV therapy may depend on clinical context and how well the selected antibiotic is orally absorbed. Premature discontinuation of therapy may lead to recurrence or local complications.

• #18 Thoracic actinomycosis – EMCrit Project

  https://emcrit.org/ibcc/actinomycosis/

  Actinomycosis is a chronic infection with a tendency to dissect across tissue planes, in a fashion which often mimics cancer. It is frequently misdiagnosed initially. […] Patients may improve transiently while on antibiotic therapy, but subsequently deteriorate off antibiotics. […] Preferred agents: Penicillin (all susceptible). Amoxicillin/ampicillin (all susceptible). Doxycycline (most susceptible). Macrolides (most susceptible). Clindamycin (most susceptible). […] Debridement may be helpful therapeutically, for example: Massive refractory hemoptysis. Excision of sinus tracts. Decompression of closed-space infections. […] Radiographic improvement is expected within ~1-2 months of starting therapy. Occasional patients may have underlying malignancy, so serial imaging should be used to exclude this possibility.

• #19 The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02744-z

  Actinomycosis is a chronic suppurative indolent disease that usually requires prolonged antimicrobial therapy to effectively cure the infection and prevent relapse. […] The mean antimicrobial duration was 160 days for treating CNS actinomycosis. […] The mean duration of antimicrobials was 150 days in isolated CNS cases compared to 200 days in disseminated actinomycosis. […] Penicillin was the most frequently used antimicrobial, followed by ceftriaxone and ampicillin (47%, 29% and 11%, respectively). […] The exact antimicrobial regimen and duration of therapy are not well defined in actinomycosis. […] We recommend at least 36 months of antibiotics in CNS actinomycosis, which can be extended if an adequate clinical response is not achieved or source control (surgery) is not possible.

• #20 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/actinomycosis-2/

  While there is general consensus that actinomycosis requires a long period of treatment, the evidence-base for optimal treatment is unsatisfying. This is a result of the rarity of the condition, the variety of clinical manifestations, the lack of validated in vitro susceptibility testing and the presence or absence of co-infecting agents. The suggestion that initial intravenous treatment is necessary has been challenged in several case series including one from Korea with 28 patients treated for thoracic actinomycosis. The duration of oral antibiotics ranged from 76-412 days, but the bulk of patients got less than 3 days of IV treatment and there were no relapses noted in the follow-up period. A review of the treatment of cervicofacial actinomycosis supported penicillin as the drug of choice with a treatment duration of 2-12 months. Some experts prefer amoxicillin clavulanate for better coverage of anaerobes other than Actinomyces.

• #21 A Rare Case of Abdominal Actinomycosis Mimicking Cancer | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n4/04-gagnon-konamna-abdominal-actinomycosis/

  Actinomycosis is a rare bacterial infection caused by Actinomyces species in humans. […] Diagnosis is challenging because laboratory, radiologic, and endoscopic findings are nonspecific, with surgery being necessary in 90% of cases to confirm the infection. […] The gold standard treatment of actinomycosis is IV penicillin G (10 to 20 million units every 6 hours) for 6 to 12 months. […] Typically, the treatment should last one to two months after the complete resolution of the infection. […] Ceftriaxone is a good alternative for penicillin-allergic patients. […] If a polymicrobial infection is found, piperacillin-tazobactam is the agent of choice. […] Surgical debridement may be required if the patient fails to respond to antimicrobial treatment. […] Surgical resection is recommended for failure of medical management, symptomatic stenosis, necrosis, fistulas, or sinus tracts. […] Cure rate and long-term prognosis are excellent; once treatment is completed, there is no recommended long-term follow-up. […] If neoplasm is not found, the primary treatment consists of long-term administration of penicillin G or amoxicillin/clavulanic acid and monitoring the response.

• #22 Actinomycosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/actinomycosis

  Extensive and repeated surgical procedures may be required. Sometimes small abscesses can be aspirated; large ones are drained, and fistulas are excised surgically. […] High-dose penicillin is usually effective but must be given long-term (8 weeks to 1 year). […] Surgery to drain abscesses and excise fistulas may be needed.

• #23

  https://journals.lww.com/mtsm/fulltext/2022/06010/actinomycosis_in_head_and_neck_region___a_review.1.aspx

  Actinomycosis is an uncommon chronic disease caused by filamentous Actinomyces, a Gram-positive anaerobic bacterium that usually colonizes in the human oral cavity, digestive tract, and genital area. […] The surgical excision of the lesion/mass along with appropriate antibiotic therapy is important treatment options. […] Actinomycosis patients need prolonged high doses of penicillin G or amoxicillin and the period of antimicrobial treatment can be shortened to a minimum of 3 months in patients in whom optimum surgical resection of the infected tissues has been useful. […] The treatment is based on a combination of surgical excision and long-term antibiotic therapy. The surgical treatment is usually indicated for resection of the necrotic tissue, curettage of the bone, excision of sinus tracts, and drainage of the abscess.

• #24 Actinomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482151/

  The duration of therapy is usually 6 to 12 months but can be shortened if surgical resection of the infected site has been performed. Type of surgery will depend upon the site and extent of the disease, but it usually involves incision and drainage of abscesses, decompression of closed space, and excision of sinus tracts. […] The response to treatment can be monitored with imaging. […] Prolonged antibiotic therapy is usually required, and the prognosis is excellent. With better oral hygiene, availability of antibiotics, and advanced surgical techniques, the outcome, and mortality have improved. For extensive and complicated disease, antibiotics and surgical treatment are required. In these cases, morbidity is high, and death may occur. […] Actinomycosis is best managed by an interprofessional team that includes an infectious disease specialist, intensivist, general surgeon, endocrinologist, and an internist.

• #25 Actinomycosis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/actinomycosis

  Treatment of actinomycosis usually requires antibiotics for several months to a year. Surgical drainage or removal of the affected area (lesion) may be needed. If the condition is related to an IUD, the device must be removed. […] Full recovery can be expected with treatment. […] Contact your provider if you develop symptoms of this infection. Starting treatment right away helps quicken the recovery.

• #26

  https://journals.lww.com/mtsm/fulltext/2022/06010/actinomycosis_in_head_and_neck_region___a_review.1.aspx

  The treatment of actinomycosis consists of oral administration of penicillin and patient often show complete regression of the lesion with this antibiotic. […] Penicillin acts as the first-line antibiotic, despite the lack of consensus regarding the most appropriate dose regimen. […] Patients who are allergic to penicillin can take other classes of antibiotics such as macrolides, rifampicin, clindamycin, tetracyclines, lincomycin, or chloramphenicol. […] Preventive measures such as low alcohol abuse and improvement of dental hygiene may reduce the improvement of dental hygiene, may limit the occurrence of cervicofacial, pulmonary, and central nervous of cervicofacial, pulmonary, and CNS actinomycosis. […] Surgery is helpful for both diagnosis and treatment of actinomycosis, although long-term antibiotic treatment is an important part of therapy.

• #27 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4094581/

  Antimicrobial therapy is the main treatment for genitourinary tract actinomycosis. Patients with genitourinary tract actinomycosis usually receive several weeks of intravenous high doses of a beta-lactam, followed by oral therapy for 2-6 months. […] Prolonged antimicrobial therapy is required for the treatment of digestive tract actinomycosis. […] The treatment strategy for extrafacial bone and joint actinomycosis is similar to that of other chronic bone and joint infections. […] The treatment of actinomycosis brain abscess requires prolonged antimicrobial therapy after pus aspiration. […] In patients with primary skin and soft-tissue actinomycosis, abscesses have to be drained and prolonged antimicrobial therapy is required to achieve cure.

• #28 Cervicofacial actinomycosis with an atypical presentation – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/cervicofacial-actinomycosis-with-an-atypical-presentation/

  Cervicofacial actinomycosis, also called lumpy jaw, is a chronic, suppurative and granulomatous bacterial infection caused mostly by Actinomyces species and rarely by Propionicusbacterium species. […] A diagnosis of actinomycosis was made, and the patient was treated with oral amoxicillin with clavulanic acid 625 mg thrice daily and oral doxycycline 100 mg twice daily. The lesions resolved completely after 5-months. […] Amoxicillin, clavulanic acid and minocycline are the first-line treatment options for penicillin-sensitive and penicillin-allergic patients, respectively. Carbapenems and tigecycline are used as second-line treatment options in severe cases. Treatment duration may range from 6 to 12 months. […] Our patient responded to the combination of amoxicillin/clavulanic acid and doxycycline with complete resolution in five months. The combination treatment was given to prevent resistance to amoxicillin.

• #29 Diagnosis and Management of Cervicofacial Actinomycosis: Lessons from Two Distinct Clinical Cases

  https://www.mdpi.com/2079-6382/9/4/139

  Members of the Actinomyces genus are non-spore-forming, anaerobic, and aerotolerant Gram-positive bacteria that are abundantly found in the oropharynx. […] The therapy of these infections includes surgical debridement and antibiotic therapy, mainly with a penicillin-derivative or clindamycin. […] The gold standard for the diagnosis of cervicofacial actinomycosis is culture, with or without histological examination of a tissue sample, pus, or abscess. […] The therapy of these infections includes surgical debridement and antibiotic therapy: based on literature data, the first-line therapy of actinomycosis is a standard high-dose intravenous penicillin G (12–24 million U/day for adults) or ampicillin therapy for 2–6 weeks, which should be switched to penicillin V or amoxicillin per os for 6–12 months, to prevent a relapsing infection.

• #30 What Is Cervicofacial Actinomycosis?

  https://www.icliniq.com/articles/infectious-diseases/cervicofacial-actinomycosis

  Actinomycosis is a chronic infectious disease with worldwide distribution caused by microaerophilic and anaerobic bacteria in the oral cavity. […] The treatment for cervicofacial actinomycosis typically involves a prolonged course of antibiotics. The antibiotics of choice are usually penicillin-based, such as high-dose penicillin G or amoxicillin. In some cases, surgical intervention may be required to drain abscesses or remove the affected tissue. […] Especially antibiotics like penicillin for the main cornerstone for treating cervicofacial actinomyces. The organisms causing the condition are susceptible to b lactam antibiotics. Initial treatment starts with high-dose penicillin therapy along with wide surgical excision of the infected tissue and then long-continued penicillin therapy of two to five million IU per 12-18 months after excision. Long-term antibiotic therapy eradicates signs and activity of the diseases and precludes reactivation. Another approach is three to six weeks of oral antibiotic therapy along with surgical drainage is curative for cervicofacial actinomycosis. In advanced cases where the individuals do not respond to the penicillin therapy, alternative therapy with sulfa drugs like Sulfamethoxazole. In cases with unresponsiveness to antibiotic therapy and aggressive lesions involving the orbital region, the antibiotic Bactrim is recommended.

• #31 Pulmonary actinomycosis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/pulmonary-actinomycosis

  The goal of treatment is to cure the infection. It may take a long time to get better. To be cured, you may need to receive the antibiotic penicillin through a vein (intravenously) for 2 to 6 weeks. Then you need to take penicillin by mouth for a long period. Some people need up to 18 months of antibiotic treatment. […] If you cannot take penicillin, your provider will prescribe other antibiotics. […] Surgery may be needed to drain fluid from the lungs and control the infection.

• #32 Pulmonary Actinomycosis: Treatments and More

  https://www.healthline.com/health/pulmonary-actinomycosis

  Treatment is generally successful in most cases, but it can be a lengthy process. […] Penicillin is the most common antibiotic treatment. Its usually given in injections for two to six weeks. Then, oral penicillin or amoxicillin is used for 8 to 12 months. It can take up to 18 months of treatment for a cure. […] If youre allergic to penicillin, your doctor will prescribe alternate antibiotics like cefazolin or clindamycin. […] You might need to have fluid surgically drained from your pleural cavity. Excess fluid in your pleural cavity, called pleural effusion, can have adverse effects on your lungs. This condition is potentially life-threatening. […] Surgery can also be used to address tissue damage in your lungs.

• #33 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Antimicrobial therapy is the main treatment for genitourinary tract actinomycosis. Patients with genitourinary tract actinomycosis usually receive several weeks of intravenous high doses of a beta-lactam, followed by oral therapy for 2-6 months. […] The treatment strategy for extrafacial bone and joint actinomycosis is similar to that of other chronic bone and joint infections. In all patients with extrafacial bone and joint actinomycosis, antimicrobial therapy must be based on prolonged high-dose intravenous and then oral beta-lactam therapy, as described in the cervicofacial actinomycosis section.

• #34 Pelvic actinomycosis in a woman without the presence of an intrauterine device – Women’s Healthcare

  https://www.npwomenshealthcare.com/pelvic-actinomycosis-in-a-woman-without-the-presence-of-an-intrauterine-device/

  Pelvic actinomycosis is considered a diagnostic challenge due to its inconspicuous and prolonged clinical course involving non-specific symptoms. […] Antibiotic therapy is the cornerstone of actinomycosis treatment, but surgical intervention designed to remove the infected tissue may be warranted in some cases. […] The prognosis for the patient without extensive or complicated disease is excellent with appropriate antibiotic therapy. […] Long-term intravenous antibiotic therapy in conjunction with surgical intervention may be warranted depending on imaging findings, severity of symptoms, and lack of improvement with oral antibiotic treatment.

• #35 Tubo-ovarian abscess secondary to actinomycosis: unexpected presentation and its treatment | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1007/s10397-014-0871-3

  This is a case of an ovarian actinomycosis diagnosed as a complex ovarian cyst by ultrasound in asymptomatic patient. […] She received 2 weeks of daily IV 1 g of ceftriaxone, followed by 6 months of oral amoxicillin. […] The usual recommended antibiotic regimen is intravenous penicillin G (1824 million units/day) for 26 weeks, followed by oral penicillin or amoxicillin for 612 months. […] Treatment of actinomycosis consists of adequate surgery, such as drainage of the abscess and reduction of infected tissue and long-term antibiotic therapy.

• #36 The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02744-z

  High-dose penicillin is the most widely used therapy for CNS disease. […] Surgical intervention (debridement of necrotic tissue, abscess drainage) becomes vital in CNS disease. […] In this review, early surgery was found to be an independent factor in improving the outcomes. Thus, it should not be reserved only for cases with a poor response to antibiotics.

• #37 Actinomycosis – Wikipedia

  https://en.wikipedia.org/wiki/Actinomycosis

  Actinomyces bacteria are generally sensitive to penicillin, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycycline is used. Sulfonamides such as sulfamethoxazole may be used as an alternative regimen at a total daily dosage of 24 grams. Response to therapy is slow and may take months. Hyperbaric oxygen therapy may also be used as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment.

• #38 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/actinomycosis-3/

  Three months of therapy appears to be the minimum required for long-term success, although treatment failures with long latent periods (up to 16 years) have been reported with longer courses. […] Surgical debridement or excision of the abscess is not always needed, but can be performed in cases of antibiotic failure, rapid progression of disease, or for cosmetic reasons. […] The use of hyperbaric oxygen in refractory cases of actinomycosis is supported by several trials; however, it should only be used as an adjunct to concurrent medical therapy. […] Close follow-up of a patient with actinomycosis is critical to the successful treatment of the disease. […] Important counseling to give to the patient and family revolve around strict compliance with therapy. […] Treatment of cutaneous actinomycosis is relatively straightforward, especially when microbiologic susceptibility studies have been performed prior to antibiotic therapy.

• #39 Effective Hyperbaric Oxygen Therapy For Actinomycosis TreatmentAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontResetSitemap

  https://hyperbaricoxygeninstitute.com/hyperbaric-oxygen-therapy-actinomycosis/

  Actinomycosis is a rare but serious infection caused by bacteria that can affect various parts of the body, including the head and neck, chest, and abdomen. Although antibiotics are the first-line treatment for Actinomycosis, they may not be sufficient in severe cases or when the infection does not respond to therapy. […] Hyperbaric oxygen therapy (HBOT) is a well-established and effective adjunctive therapy for Actinomycosis. HBOT involves breathing pure oxygen in a pressurized chamber, which increases the oxygen supply to the tissues and enhances the body’s ability to fight infection and promote healing. […] However, hyperbaric oxygen therapy (HBOT) has emerged as a promising adjunctive therapy for Actinomycosis treatment in recent years. This therapy involves breathing 100% oxygen in a pressurized chamber, which increases the amount of oxygen in the blood and tissues. This, in turn, can enhance the body’s natural healing processes and help fight off bacterial infections like Actinomycosis.

• #40 Effective Hyperbaric Oxygen Therapy For Actinomycosis TreatmentAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontResetSitemap

  https://hyperbaricoxygeninstitute.com/hyperbaric-oxygen-therapy-actinomycosis/

  Hyperbaric oxygen therapy (HBOT) is increasingly being recognized as an effective adjunctive therapy for Actinomycosis. This therapy involves exposing the patient to 100% oxygen at a higher atmospheric pressure than what is normally experienced at sea level, enhancing the oxygenation of tissues, and promoting healing. HBOT is a safe medical treatment that has shown numerous benefits for Actinomycosis patients. […] The main advantages of HBOT for Actinomycosis patients are: Enhanced effectiveness of antibiotics and other traditional treatments, Promotion of healing and regeneration of tissues, Improvement in tissue oxygenation and angiogenesis, Reduction in the need for invasive surgeries, Potential reduction in the duration of antibiotic treatment, Faster recovery, Improved quality of life.

• #41 Effective Hyperbaric Oxygen Therapy For Actinomycosis TreatmentAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontResetSitemap

  https://hyperbaricoxygeninstitute.com/hyperbaric-oxygen-therapy-actinomycosis/

  Studies have also shown that HBOT has additional benefits for Actinomycosis patients. These include: Reduction in inflammation and swelling, Improved circulation, Promotion of stem cell production and wound healing, Reduction in pain and discomfort, Potential reduction in the risk of recurrence of Actinomycosis. […] HBOT is a safe and effective therapy for Actinomycosis that has numerous benefits for patients. By promoting tissue healing and regeneration, enhancing traditional treatment options, and reducing the need for invasive surgeries, HBOT can provide patients with faster recovery times, improved quality of life, and a reduced risk of complications. […] Hyperbaric oxygen therapy (HBOT) has shown remarkable effectiveness in the treatment of Actinomycosis. Studies have reported success rates of up to 94% when the therapy is used as an adjunctive treatment with antibiotics.

• #42 Effective Hyperbaric Oxygen Therapy For Actinomycosis TreatmentAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontResetSitemap

  https://hyperbaricoxygeninstitute.com/hyperbaric-oxygen-therapy-actinomycosis/

  Overall, the evidence strongly supports the effectiveness of HBOT as a safe and reliable treatment option for Actinomycosis. […] The treatment process is designed to deliver a sufficient amount of oxygen to the affected area, which helps in eradicating the harmful bacteria and enhancing the body’s healing capacity. The treatment is often used in conjunction with traditional antibiotics and surgery to achieve the best results. […] Overall, HBOT is considered a safe and effective adjunctive therapy for Actinomycosis management, with few reported side effects when administered by qualified professionals. […] Research has shown that Actinomycosis patients who receive HBOT in combination with traditional antibiotic therapy have a higher chance of achieving full remission and experiencing a faster recovery time than those who only receive antibiotic treatment.

• #43 Effective Hyperbaric Oxygen Therapy For Actinomycosis TreatmentAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontResetSitemap

  https://hyperbaricoxygeninstitute.com/hyperbaric-oxygen-therapy-actinomycosis/

  Therefore, HBOT can be a useful adjunctive therapy for Actinomycosis patients looking for a safe, effective, and non-invasive treatment option. […] Hyperbaric oxygen therapy has shown promising results in effectively managing Actinomycosis. […] These case studies highlight the efficacy of hyperbaric oxygen therapy as an adjunctive treatment for Actinomycosis. […] There are several benefits of using hyperbaric oxygen therapy (HBOT) as a treatment option for Actinomycosis. […] By promoting faster healing and reducing the need for invasive procedures, HBOT can significantly improve the overall quality of life for Actinomycosis patients. […] While there are potential risks and side effects associated with hyperbaric oxygen therapy, the benefits for Actinomycosis patients generally outweigh the risks. With proper management and monitoring, HBOT can be a safe and effective treatment option for Actinomycosis.

• #44 Actinomycosis – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/actinomycosis

  Drainage of abscesses […] Treatment of actinomycosis consists of […] Draining abscesses with a needle (usually inserted through the skin) or with surgery […] Giving high doses of antibiotics […] Antibiotics such as penicillin or tetracycline must be taken for at least 2 months and may be needed for more than 12 months. […] CT or magnetic resonance imaging (MRI) may be used to determine whether abscesses are resolving. Surgery may be necessary, particularly if the infection affects critical areas such as the spine. […] Women who have pelvic actinomycosis have their IUD removed and are given penicillin. An extensive pelvic infection may require additional drainage of abscesses. Sometimes the uterus, fallopian tubes, and ovaries need to be removed.

• #45 Actinomycosis

  https://www.nhs.uk/conditions/actinomycosis/

  Actinomycosis is a rare type of bacterial infection. It can be very serious but can usually be treated with antibiotics. […] Actinomycosis is treated with antibiotics. Treatment starts off in hospital with antibiotics given directly into a vein (intravenously). […] When you’re well enough to go home, you’ll be given antibiotic tablets to take for a few months. […] It’s important to keep taking antibiotics until they’re finished, even when you feel better. […] You might also need surgery to drain areas of pus (abscesses) and remove the surrounding area of skin if it’s infected.

• #46 Actinomycosis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/actinomycosis

  Antibiotics are the primary treatment for actinomycosis. High doses of penicillin are usually necessary to cure the infection. If you’re allergic to penicillin, your doctor can give you other antibiotics, such as: […] It can take up to a year for the antibiotics to completely cure the infection. […] Any skin eruptions, or abscesses, from the infection may need to be drained or removed. If you developed actinomycosis due to the use of an IUD, the device should be removed to prevent further infection. […] Notify your doctor immediately if you have the symptoms of actinomycosis. Early, aggressive treatment decreases your likelihood of developing long-term complications and requiring surgery.

• #47 Actinomycosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17126

  Prolonged antibiotic therapy is usually required, and the prognosis is excellent. With better oral hygiene, availability of antibiotics, and advanced surgical techniques, the outcome, and mortality have improved. For extensive and complicated disease, antibiotics and surgical treatment are required. In these cases, morbidity is high, and death may occur.

• #48

  https://link.springer.com/article/10.1007/s11908-005-0030-0

  Cervicofacial actinomycosis is an uncommon but fascinating infection of the head and neck. […] Penicillin is the drug of choice and is usually administered for 2 to 12 months, although short-course treatment may cure uncomplicated infection. […] Surgical therapy is often indicated for curettage of bone, resection of necrotic tissue, excision of sinus tracts, and drainage of soft tissue abscesses. […] The prognosis for treated infection is excellent. […] Sudhakar S, Ross J: Short-term treatment of actinomycosis: two cases and a review. This paper describes cases of esophageal and cervicofacial actinomycosis treated successfully with short-term ( 6 months) antibiotic therapy and reviews the literature, contrasting it with more prolonged treatment needed for neglected, advanced disease and for patients previously receiving interrupted therapy at suboptimal dosages.

• #49 Pelvic Actinomycosis: Multidisciplinary Approach for Successful Treatment – a Case Report by Anna Moniuszko, Justyna Adamczuk, Ahmad Reza Rezaei, Piotr Czupryna, Mariusz Kuźmicki :: SSRN

  https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4830807

  Pelvic actinomycosis is a rare but potentially serious bacterial infection that affects the pelvic organs in men, including the prostate, and the pelvic region in women, particularly the uterus, fallopian tubes, and ovaries. […] This report outlines the case of pelvic actinomycosis in a 59-year-old Polish female, emphasizing the importance of a multidisciplinary approach involving prolonged antibiotic therapy and timely surgical intervention. […] Despite initial partial relief with antibiotics, persistent bleeding prompted surgery, resulting in successful treatment completion without complications. […] Our findings also emphasize the need for prompt management to prevent complications.

• #50 Innovative Techniques in the Diagnosis and Treatment of Actinomyc

  https://www.longdom.org/open-access/innovative-techniques-in-the-diagnosis-and-treatment-of-actinomycosis-107973.html

  Actinomycosis is a rare, chronic bacterial infection caused primarily by the Actinomyces species, which are Gram-positive, anaerobic bacteria. […] Treatment of actinomycosis involves a combination of long-term antibiotic therapy and, in some cases, surgical intervention. […] Antibiotics: The first-line treatment, often administered intravenously for 2-6 weeks, followed by oral penicillin or amoxicillin for 6-12 months to ensure complete eradication of the infection. […] Surgical intervention: Necessary in cases where there is extensive abscess formation, necrotic tissue, or when the infection is not responsive to antibiotics alone. Surgery may involve draining abscesses, debriding infected tissue, or removing any foreign bodies. […] Long-term antibiotic therapy remains the core of treatment, supplemented by surgical intervention when necessary.

• #51 Navigating the Treatment Landscape for Actinomycosis: Strategies for Eradicating Chronic Bacterial Infection – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/navigating-treatment-landscape-actinomycosis-strategies-eradicating-chronic-bacterial-infection

  Treating actinomycosis requires a multidimensional approach aimed at eradicating bacterial infection, resolving inflammation, and preventing recurrence. This article outlines the therapeutic strategies and challenges encountered in managing actinomycosis. […] Antibiotics are the cornerstone of actinomycosis treatment, targeting the underlying bacterial infection: […] First-Line Agents: Penicillin G or amoxicillin-clavulanate are the preferred antibiotics for treating actinomycosis due to their activity against Actinomyces species. […] Duration: Prolonged courses of antibiotics are necessary, typically ranging from 6 to 12 months, to ensure complete eradication of the infection and prevent recurrence. […] Alternative Agents: In cases of penicillin allergy or resistance, alternative antibiotics such as doxycycline, clindamycin, or macrolides may be considered.

• #52 Navigating the Treatment Landscape for Actinomycosis: Strategies for Eradicating Chronic Bacterial Infection – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/navigating-treatment-landscape-actinomycosis-strategies-eradicating-chronic-bacterial-infection

  Surgical drainage or debridement may be necessary for localized abscesses, tissue masses, or refractory infections: […] Indications: Surgical intervention is indicated for large abscesses, extensive tissue involvement, or failure to respond to antibiotic therapy. […] Abscess Drainage: Percutaneous or surgical drainage of abscesses facilitates the removal of purulent material and necrotic debris, aiding in infection control. […] Tissue Excision: Surgical excision may be required for localized masses, sinuses, or areas of tissue necrosis to achieve complete clearance of the infection. […] Adjunctive therapies and supportive measures complement antibiotic treatment and promote optimal outcomes: […] Pain Management: Analgesics may be necessary to alleviate discomfort associated with inflammation, tissue induration, or surgical interventions.

• #53 Navigating the Treatment Landscape for Actinomycosis: Strategies for Eradicating Chronic Bacterial Infection – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/navigating-treatment-landscape-actinomycosis-strategies-eradicating-chronic-bacterial-infection

  Nutritional Support: Ensuring adequate nutrition and hydration supports immune function and facilitates tissue healing and repair. […] Wound Care: Regular wound care and monitoring are essential for preventing secondary infections, promoting tissue healing, and minimizing scarring. […] Long-term surveillance and follow-up are crucial for monitoring treatment response, detecting recurrence, and addressing complications: […] Clinical Monitoring: Regular clinical evaluations and imaging studies assess treatment response, resolution of symptoms, and the need for ongoing therapy adjustments. […] Recurrence Prevention: Prophylactic antibiotic therapy or maintenance therapy may be considered in high-risk individuals to prevent recurrence, particularly those with predisposing factors or extensive disease.

• #54 Navigating the Treatment Landscape for Actinomycosis: Strategies for Eradicating Chronic Bacterial Infection – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/navigating-treatment-landscape-actinomycosis-strategies-eradicating-chronic-bacterial-infection

  The treatment of actinomycosis requires a multifaceted approach involving antibiotic therapy, surgical intervention, supportive measures, and long-term follow-up. Understanding the challenges and considerations associated with managing this chronic bacterial infection is essential for achieving successful outcomes.

• #55

  https://journals.lww.com/md-journal/fulltext/2018/04200/brain_abscess_caused_by_chronic_invasive.24.aspx

  Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is part of the normal flora in the oral cavity and respiratory and female genitourinary tracts. […] The patient was treated by surgical drainage of the brain abscess and long-term antibiotic treatment. […] According to the findings in a limited number of studies, the criterion standard for the treatment of actinomycosis is long-term antibiotic therapy with or without surgical intervention. […] Surgical intervention, including drainage of voluminous abscesses, marsupialization of chronic sinus tracts, and/or debridement of necrotic tissues, is often necessary to not only establish a diagnosis but also alleviate the disease. […] Therefore, physicians should be aware of the typical clinical presentations of cervicofacial actinomycosis. Moreover, they should know that actinomycosis may mimic the process of malignancy at various anatomical locations. […] Finally, the possibility of frequent relapses necessitates long-term follow-up after adequate treatment.

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