Pediatric Actinomycosis Medication

Updated: Oct 28, 2021
  • Author: Jorge M Quinonez, MD; Chief Editor: Russell W Steele, MD  more...
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Class Summary

For most complicated cases, 4-6 wk of intravenous penicillin G followed by 6-12 months of oral penicillin V is indicated. For patients with penicillin allergy, clindamycin, ceftriaxone, chloramphenicol, and tetracyclines are good alternatives. Parenteral and oral combinations of these drugs have been successful. Because co-infection with A actinomycetemcomitans is common, covering for this organism when present is important, especially in patients who are critically ill. Actinomycosis is susceptible to third-generation cephalosporins, rifampin, trimethoprim-sulfamethoxazole, ciprofloxacin, tetracyclines, and chloramphenicol.

Penicillin G (Pfizerpen)

First-line drug. Used for IV courses of 4-6 wk. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Penicillin VK (Beepen-VK, Betapen-VK, Pen-Vee K)

First-line drug to be used as follow-up on previous parenteral therapy.

Clindamycin (Cleocin)

Second-line drug. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Chloramphenicol (Chloromycetin)

Second-line drug. The PO form is unavailable in the United States. Only use when no other alternatives are available. Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis.

Ceftriaxone (Rocephin)

Second-line drug. Arrests bacterial growth by binding to one or more penicillin binding proteins.

Tetracycline HCl (Sumycin)

Second-line drug. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).