Antibiotics are the main stay of treatment in actinomycosis. The exact antibiotic regimen depends on the site of infection, severity of disease, and the patient’s response to treatment. For cervicofacial actinomycosis, Ampicillin is administered followed by Penicillin V. Patients with more extensive disease may require surgery.

• 1. Actinomyces species including A. israeli^[1]

• Preferred regimen: Penicillin 3-4 MU IV q4h for 2-6 weeks THEN Penicillin V 2-4 g/day PO QID for 6-12 months
• Alternative regimen (1): Erythromycin 500-1000 mg IV q6h OR 500 mg PO QID
• Alternative regimen (2): Tetracyclin 500 mg PO QID
• Alternative regimen (3): Doxycycline 100 mg IV q12h OR 100 mg PO BID
• Alternative regimen (4): Clindamycin 900 mg IV q8h OR 300-450 mg PO QD
• Alternative regimen (5): Minocycline 100 mg IV q12h OR 100 mg POBID

• 2. Cervico-facial actinomycosis^[2]

• Preferred regimen: Ampicillin 50 mg/kg/day IV q8h (4-6 weeks) THEN Penicillin V 2-4 g/day PO q6h (3-6 months)
• Alternative regimen: Penicillin G 10-20 MU/day IV q6h (4-6 weeks) THEN Penicillin V 2-4 g/day PO q6h (3-6 months)
• Note: In patients allergic to Penicillin, consider Doxycycline, Clindamycin, or Erythromycin.

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