What is the treatment for recurring abscess of Streptococcus anginosus?

Treatment for Recurring Abscess of Streptococcus anginosus

For recurring abscesses caused by Streptococcus anginosus, treatment should include surgical drainage followed by a 5-10 day course of antibiotics active against the pathogen, with penicillin being the drug of choice. 1

Initial Management

• Surgical drainage is the primary treatment for any abscess and should be performed early for recurrent abscesses 1
• Culture the abscess to identify the specific pathogen and its antimicrobial susceptibility 1
• Blood cultures should be obtained if there are signs of systemic infection or bacteremia 1

Antibiotic Therapy

First-line Options:

• Penicillin G: 2-4 million units every 4-6 hours IV for severe infections 1
• Penicillin VK: 250-500 mg every 6 hours orally for less severe cases 1
• Amoxicillin: 500 mg every 8 hours orally 1

Alternative Options (for penicillin-allergic patients):

• Clindamycin: 600-900 mg every 8 hours IV or 300-450 mg four times daily orally 1
• Ceftriaxone: 2 g daily IV (if non-anaphylactic penicillin allergy) 1
• Vancomycin: For patients with severe penicillin allergy 1

Duration of Therapy

• 5-10 days of antibiotic therapy is recommended for most cases 1
• Extended therapy (up to 4 weeks) may be necessary for deep-seated or complicated infections 1, 2

Management of Recurrence

For patients with recurrent S. anginosus abscesses, consider the following:

• Evaluate for underlying conditions that may predispose to recurrent infections, such as:

  • Poor oral hygiene 3
  • Gastrointestinal tract disease 2
  • Malignancy (particularly colorectal cancer) 4, 2
  • Immunodeficiency 3

• Consider decolonization regimen (though evidence is primarily for S. aureus, may be applicable):

  • Intranasal mupirocin twice daily for 5 days 1
  • Daily chlorhexidine washes 1
  • Daily decontamination of personal items (towels, sheets, clothes) 1

Special Considerations

• S. anginosus group bacteria have a propensity to form abscesses in multiple organs including brain, liver, and lungs 3, 2
• Consider imaging studies to rule out disseminated infection, particularly in patients with systemic symptoms 5, 2
• Surgical drainage combined with appropriate antibiotics is crucial for successful treatment of deep-seated abscesses 2
• S. anginosus remains highly susceptible to penicillin (resistance is rare), making it the drug of choice 6, 2

Monitoring and Follow-up

• Monitor clinical response within 48-72 hours of initiating therapy 1

• If no improvement occurs within 5 days, consider:

  • Inadequate drainage of the abscess 1
  • Antimicrobial resistance 1
  • Presence of foreign material 1
  • Underlying undiagnosed condition 3, 4

• Follow-up imaging may be necessary to ensure resolution of deep-seated abscesses 5