Medicines for Actinomycosis

What it is

Actinomycosis is a rare bacterial infection caused by Actinomyces bacteria, which normally live harmlessly in the mouth, gut, and other areas of the body without causing problems. Infection occurs when these bacteria get into deeper tissues — for example through a break in the lining of the mouth (such as after dental problems or dental treatment), or into other areas — where they can cause a slowly developing infection. Actinomycosis is uncommon and tends to develop gradually. It most commonly affects the area around the mouth, jaw, and neck (this is the most frequent form, sometimes following dental infection or dental work), but can also affect the chest, the tummy and pelvis, and other areas. The typical features are slowly enlarging, firm lumps or swellings, which can develop into abscesses (collections of pus) and may form channels (sinuses) that discharge pus to the skin surface; the discharge sometimes contains small yellowish granules. The infection can spread gradually through the tissues, and, depending on the site, can cause various symptoms (such as a lump in the jaw or neck, or symptoms relating to the chest, tummy, or other affected area). Because it develops slowly and can resemble other conditions (including, in some cases, more serious conditions), actinomycosis can be difficult to diagnose, and is confirmed by tests (such as examining a sample of the pus or tissue). The important and reassuring point is that actinomycosis is treatable, usually with antibiotics — although, because of the nature of the infection, treatment typically requires a long course of antibiotics (often for several months) to fully clear it, and sometimes a procedure to drain an abscess or remove infected tissue. With appropriate, complete treatment, actinomycosis is usually cured. The key messages are that actinomycosis is a rare bacterial infection causing slowly developing lumps and abscesses (often around the mouth, jaw, or neck), and that it is treatable, usually with a long course of antibiotics.

How it is treated

Actinomycosis is treated with antibiotics, usually a long course, sometimes alongside draining an abscess or removing infected tissue; with complete treatment it is usually cured. Because actinomycosis develops slowly and can resemble other conditions, reaching the diagnosis often involves assessment and tests to confirm it — such as examining a sample of the pus, discharge, or tissue (which may show the characteristic bacteria or granules), imaging to assess the extent, and excluding other causes; specialist input may be needed. Once diagnosed, the mainstay of treatment is antibiotics, to which the bacteria are usually sensitive; however, a key point is that treatment typically needs to be prolonged — often a long course of antibiotics over several months — to fully clear the infection and prevent it coming back, because of the way the infection develops within the tissues. It is important to complete the full course as directed, even after symptoms improve. In many cases, alongside antibiotics, a procedure is needed to drain an abscess (collection of pus) or to remove infected or dead tissue (surgery), which helps clear the infection and speed recovery, particularly for larger abscesses or more extensive infection. Treating any underlying or contributing factor (such as a dental infection) is also part of care. With appropriate, complete treatment, actinomycosis usually responds well and is cured, though the long treatment course requires patience and adherence. Follow-up ensures the infection has cleared. The reassuring messages are that actinomycosis, although a rare and slowly developing infection that can be difficult to diagnose, is treatable and usually curable — with a long course of antibiotics, sometimes alongside draining an abscess or removing infected tissue — and that completing the full treatment is important for a full recovery; so seeking assessment for a slowly developing lump, swelling, or abscess (particularly around the mouth, jaw, or neck) that does not resolve, and completing treatment, are the keys to managing it.