From the Guidelines
For an abscess caused by Prevotella corporis, I recommend amoxicillin-clavulanate (Augmentin) as the first-line oral antibiotic treatment, typically 875/125 mg twice daily for 7-10 days. This recommendation is based on the guidelines provided by the Infectious Diseases Society of America, which suggest that amoxicillin-clavulanate is effective against anaerobic gram-negative bacteria, including Prevotella species 1.
The choice of amoxicillin-clavulanate is due to its ability to inhibit beta-lactamases, which are commonly produced by Prevotella species, making it an effective treatment option.
Alternatives for penicillin-allergic patients include:
- Clindamycin 300-450 mg four times daily
- Metronidazole 500 mg three times daily combined with a quinolone like levofloxacin 500 mg daily
In addition to antibiotics, proper drainage of the abscess is essential for complete resolution, as antibiotics alone may be insufficient for larger abscesses 1. Patients should complete the full course of antibiotics even if symptoms improve quickly, stay hydrated, and seek immediate medical attention if fever develops, the infection spreads, or symptoms worsen despite treatment. Follow-up evaluation is recommended to ensure complete resolution of the infection.
It's worth noting that the guidelines also recommend considering the patient's clinical response and adjusting the treatment accordingly, as well as taking into account any potential allergies or resistance to certain antibiotics 1.
From the FDA Drug Label
Clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections: Anaerobic bacteria Prevotella melaninogenica Prevotella bivia Prevotella intermedia
Antibiotic coverage for Prevotella corporis is likely provided by clindamycin (PO), as it has been shown to be active against other Prevotella species, such as Prevotella melaninogenica, Prevotella bivia, and Prevotella intermedia 2.
From the Research
Antibiotics for Prevotella Corporis
- The choice of antibiotics for treating Prevotella corporis infections, particularly in cases of abscesses, is crucial for effective management 3, 4.
- Studies have shown that Prevotella species exhibit varying degrees of susceptibility to different antibiotics:
- Amoxicillin-clavulanate and metronidazole have been found to be highly effective against Prevotella strains 3, 4.
- Clindamycin is also effective, although some resistance has been reported 3, 4.
- Penicillin G and ampicillin are less effective due to beta-lactamase production by some Prevotella isolates 3, 4.
Oral Antibiotics for Abscesses
- For the treatment of abscesses caused by Prevotella corporis, oral antibiotics such as amoxicillin-clavulanate, metronidazole, and clindamycin are recommended 4, 5.
- The choice of antibiotic should be based on the susceptibility pattern of the Prevotella isolate, if available 3, 6.
- In cases where the causative organism is not identified, empiric treatment with broad-spectrum antibiotics such as amoxicillin-clavulanate or metronidazole may be considered 7, 5.
Treatment Considerations
- The duration of antibiotic treatment is important, with prolonged treatment potentially reducing the risk of recurrence 5.
- Incision and drainage may be necessary in addition to antibiotic treatment for effective management of abscesses 5.
- Specific anaerobic culturing should be performed to confirm the presence of Prevotella species and guide antibiotic treatment 5.