Chest

Chest

Volume 128, Issue 4, October 2005, Pages 2211-2217
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Clinical Investigations
Optimal Duration of IV and Oral Antibiotics in the Treatment of Thoracic Actinomycosis

https://doi.org/10.1016/S0012-3692(15)52624-XGet rights and content

Study objective

IV antibiotic therapy for 2 to 6 weeks followed by 6 to 12 months of oral antibiotic therapy is usually recommended for the treatment of thoracic actinomycosis. The objective of this study was to evaluate the duration of IV and oral antibiotic therapy for thoracic actinomycosis.

Methods

We present a retrospective case series of 28 patients with thoracic actinomycosis as confirmed by histopathology from October 1994 through December 2003.

Results

After diagnosis of actinomycosis, 54% (15 of 28 patients) received antibiotic therapy alone. The duration of IV antibiotic therapy ranged from 0 to 18 days (median, 2 days; interquartile range [IQR], 0 to 3 days), and the duration of oral antibiotic treatment ranged from 76 to 412 days (median, 167 days; IQR, 142 to 214 days) in patients who received antibiotics alone. Combination surgical and antibiotic therapy occurred in 46% (13 of 28 patients). The duration of IV antibiotic therapy ranged from 3 to 17 days (median, 8 days; IQR, 5 to 13 days), and the duration of oral antibiotic therapy ranged from 0 to 534 days (median, 150 days; IQR, 3.5 to 289 days) in these patients. Clinical cures were achieved in 96% (27 of 28 patients). There was no clinical evidence of recurrence during follow-up period at our hospital (median, 23 months; IQR, 9 to 44 months) in 21 patients, excluding 7 patients who were transferred to referring hospitals after completion of antibiotic therapy (n = 6) or during antibiotic therapy (n = 1).

Conclusions

Thoracic actinomycosis is best treated with individualized therapeutic modalities, depending on factors such as the initial burden of disease, the performance of resectional surgery, and the clinical and radiologic responses to therapy. The traditional recommendation of IV antibiotic therapy for 2 to 6 weeks followed by oral antibiotic therapy for 6 to 12 months is not always necessary for all thoracic actinomycosis patients.

Section snippets

Materials and Methods

All 28 patients who received a diagnosis of thoracic actinomycosis at the Samsung Medical Center (a 1,250-bed referral hospital in Seoul, Korea) from October 1994 through December 2003 were included in the present study. Confirmatory diagnoses were based on the histopathologic findings of sulfur granules, or Gomori methenamine silver stain-positive branching filamentous organisms. Tissue specimens were obtained from purulent discharge, surgical biopsy, bronchoscopic biopsy, or percutaneous

Clinical Features and Diagnoses of Thoracic Actinomycosis

Twenty-two of the patients (79%) were men, and 6 patients (21%) were women. Their ages ranged from 38 to 81 years (median, 54 years; IQR, 46.5 to 61 years). Seventeen patients (61%) were either currently smokers or were ex-smokers. Fifteen patients (54%) exhibited underlying comorbidities, including diabetes mellitus (n = 7), hypertension (n = 5), previous treatment for pulmonary tuberculosis (n = 3), bronchiectasis (n = 3), chronic hepatitis (n = 3), and idiopathic pulmonary fibrosis (n = 1).

Discussion

The objective of this retrospective case series was to evaluate the duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. The major findings of this study are as follows: (1) many patients with thoracic actinomycosis can be successfully treated with oral antibiotic therapy, either combined with short-term IV antibiotics, or even without IV antibiotics, after diagnosis is made by nonsurgical procedures; and (2) a substantial proportion of patients with thoracic

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This work was supported by grant R11–2002-103 from the Korea Science and Engineering Foundation.

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    Copyright © 2005 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.