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Therapeutic Strategies


Timothy Berger Bruce Wintroub

Saturday, January 01, 2011

Initial Steps

Treatment is with parenteral penicillin 10-20 X 106 U/day for 2-4 weeks.

Additional Steps

For the penicillin-allergic patient, prescribe sulfamethoxazole/trimethoprim DS (800/160) 3-5 tablets daily (2.4 to 4.0 g sulfamethoxazole daily).

Subsequent Steps

  1. It is important to look for underlying bony involvement, especially in the case of cervicofacial actinomycosis. Eradication of an underlying dental source may enhance healing and prevent relapse. Surgical intervention to drain and eradicate loculated and scarred foci may be beneficial. 
  2. After 2-4 weeks of parenteral penicillin, switch to oral penicillin V 500 mg q.i.d. Continue therapy for at least 6 months or until the lesion has been stable or has appeared healed for 3 months, whichever is longer.


  1. Failure to evaluate lesions by appropriate cultures and biopsy often delays diagnosis. 
  2. Premature termination of therapy often leads to relapse. 
  3. Evaluate patient for immunosuppression, as immunocompetent patients may require longer treatment courses.

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