Treatment of Actinomycosis
Actinomycosis is a bacterial infection of the skin, muscle, and fat of the jaw. It is caused by the bacteria Actinomyceswhich normally grows in the mouth without causing problems. For an active infection to occur, there must be trauma to the mouth area, such as severely decayed or carious teeth, a recent tooth extraction, or a cut or bruise of the oral mucosa.
Actinomycosis is unusual for an infection in that it does not follow the normal tissue planes but
rather burrows through them. It may erupt onto the skin and may even mimic a tumor. It is usually painful until the infection develops multiple draining sinus tracts.
The classic finding in the disease famous to all medical students is the presence of “sulfur granules” in the draining fluid or exudate. The typical course of the infection is an initial positive response to antibiotics with the infection returning in the same area after the antibiotics are stopped. Inexperienced clinicians will sometimes treat with multiple courses of antibiotics, trying to eradicate the infection.
However, the definitive treatment requires complete excision of the mass and all draining sinus tracts and should be done by an experienced oral surgeon. The antibiotic of choice is penicillin. Most oral surgeons recommend doxycycline or minocycline if the patient has a penicillin allergy.
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