**6. Treatment for actinomycosis**

The management of actinomycosis infection consists of prolong antimicrobial therapy, but surgical debridement and resection may be indicated in some cases. The use of antimicrobials has greatly improved the prognosis. Drug resistance is not considered a problem in actinomycosis and tends to be susceptible to beta-lactams antibiotics [22]. For patients with monomicrobial infections, treatment can be divided base on mild versuss severe disease. If the infection involves an organ causing a life threatening disease or multiple organs, it is considered severe. For mild actinomycosis, initial oral therapy with penicillin V (divided in four daily doses) is recommended [23]. For severe infection, initial course of 10 to 20 million units daily of intravenous penicillin G (divided into four to six hours) is recommended [22]. If the patient has penicillin allergy, a cephalosporin or doxycycline can be use [24].

As mentioned before, Actinomyces can grow with other organisms in tissue and sample cultures in almost 75 to 95% of cases [10]. The other organisms are usually anaerobic from the oral flora, and they can produce beta-lactamases that can protect actinomyces from penicillin.In those cases a combination of a beta-lactam plus beta-lactamase inhibitor is recommended as treatment.

Antimicrobial treatment should be continued until resolution of infection, usually between 6 and 12 months [25]. Actinomycosis infection can recur, especially in thoracic infections without surgical debridement [25]. Therapy duration of less than 3 months should be avoided in those cases. When infection complicates with abscess and fistula formation, surgical management and drainage is warranted, especially in life threatening presentations.
