From the Research
The recommended treatment for a sexually transmitted infection with an abscess where Streptococcus intermedius is identified on culture is a combination of surgical drainage of the abscess and antibiotic therapy. The abscess should be incised and drained as the primary intervention, followed by antibiotic treatment with penicillin G (2-4 million units IV every 4-6 hours) or ampicillin (2g IV every 4-6 hours) for severe infections, as supported by the most recent study 1. For less severe cases, amoxicillin (500mg orally three times daily for 7-10 days) is appropriate. In penicillin-allergic patients, clindamycin (600-900mg IV every 8 hours or 300-450mg orally four times daily) is an effective alternative.
Key Considerations
- S. intermedius is part of the Streptococcus anginosus group and is known for its propensity to form abscesses, which are generally susceptible to beta-lactam antibiotics 2.
- The combination of surgical drainage and antimicrobial therapy is crucial for effective treatment as antibiotics alone may not adequately penetrate the abscess 1.
- Follow-up evaluation is important to ensure complete resolution of the infection, and sexual partners should be notified and treated to prevent reinfection.
Treatment Approach
- Surgical drainage of the abscess is the primary intervention.
- Antibiotic therapy should be initiated promptly after drainage.
- The choice of antibiotic should be based on the severity of the infection and the patient's allergy status.
- The full course of antibiotics typically lasts 7-14 days depending on clinical response, as seen in cases where patients were treated with a combination of surgical drainage and antibiotic therapy 1, 3.
Special Considerations
- In cases where the patient is penicillin-allergic, alternative antibiotics such as clindamycin should be used.
- The treatment approach may need to be adjusted based on the patient's clinical response and the results of follow-up evaluations.
- It is essential to consider the potential for complications, such as discitis, as reported in a case where S. intermedius caused a lung abscess that led to discitis by contiguous spread of infection 3.