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Anaerobic Infections, Head & Neck

For further information, see CMDT Part 33-31: Anaerobic Infections

Key Features

  • Prevotella melaninogenica and anaerobic spirochetes are commonly involved in periodontal infections

  • These organisms, fusobacteria, and peptostreptococci may cause

    • Chronic sinusitis

    • Peritonsillar abscess

    • Chronic otitis media

    • Mastoiditis

  • Fusobacterium necrophorum has been recognized as a common cause of pharyngitis in adolescents and young adults

  • F necrophorum infection has been associated with septic internal jugular thrombophlebitis (Lemierre syndrome) and septic pulmonary embolization

Clinical Findings

  • Related to infected organ

Diagnosis

  • Culture

  • CT scan

Treatment

  • Tables 30–4 and 30–5

  • Penicillin alone is inadequate for infections caused by oral anaerobic organisms because of increasing penicillin resistance, usually due to β-lactamase production; therefore, the following can be used:

    • Ampicillin/sulbactam, 1.5–3 g intravenously every 6 hours (if parenteral therapy is required) or

    • Amoxicillin/clavulanic acid, 875 mg/125 mg orally twice daily or

    • Clindamycin, 600 mg intravenously every 8 hours or 300 mg orally every 6 hours

  • Antimicrobial treatment is continued for a few days after symptoms and signs have resolved

  • Indolent, established infections (eg, mastoiditis or osteomyelitis) may require prolonged courses of therapy (eg, 4–6 weeks or longer)

  • Hygiene, drainage, and surgical debridement are as important in treatment as antimicrobials

Table 30–4.Medication of choice for suspected or documented microbial pathogens (listed in alphabetical order, within classes).
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Table 30–4. Medication of choice for suspected or documented microbial pathogens (listed in alphabetical order, within classes).
Suspected or Proved Etiologic Agent Medication(s) of First Choice Alternative Medication(s)

Gram-Negative Cocci

Moraxella catarrhalis

Cefuroxime, amoxicillin-clavulanic acid

Ceftriaxone, cefuroxime axetil, a fluoroquinolone,1 a macrolide,2 a tetracycline,3 TMP-SMZ4

Neisseria gonorrhoeae (gonococcus)

Ceftriaxone + azithromycin or doxycycline

Cefixime + azithromycin or doxycycline5

Neisseria meningitidis (meningococcus)

Penicillin6

Ceftriaxone, ampicillin

Gram-Positive Cocci

Enterococcus faecalis

Ampicillin ± gentamicin7

Ampicillin ± ceftriaxone

Vancomycin ± gentamicin

Enterococcus faecium

Vancomycin ± gentamicin7

Linezolid,8 quinupristin-dalfopristin,8 daptomycin,8 tigecycline,8 tedizolid,8 oritavancin8

Staphylococcus, methicillin-susceptible

Cefazolin

or

Penicillinase-resistant penicillin10

Vancomycin, a cephalosporin,9 clindamycin, amoxicillin-clavulanic acid, ampicillin-sulbactam

Staphylococcus, methicillin-resistant

Vancomycin

TMP-SMZ,4 doxycycline, minocycline, linezolid,8 tedizolid,8 daptomycin,8 televancin,8 dalbavancin,8 oritavancin,8 ceftaroline, delafloxacin

Streptococcus, hemolytic, groups A, B, C, G

Penicillin6

Macrolide,2 a cephalosporin,9 vancomycin, clindamycin

Streptococcus pneumoniae11 (pneumococcus)

Penicillin6

A cephalosporin,9 vancomycin, clindamycin, a tetracycline,3 respiratory fluoroquinolones1

Viridans streptococci

Penicillin6

Cephalosporin,9 vancomycin

Gram-Negative Rods

Acinetobacter

Imipenem, meropenem

Tigecycline, minocycline, doxycycline, aminoglycosides,12 colistin, cefiderocol

Bacteroides, GI strains

Metronidazole

Ampicillin-sulbactam, piperacillin-tazobactam, ertapenem

Brucella

Doxycycline + rifampin3

TMP-SMZ4 ± gentamicin; ciprofloxacin + rifampin

Burkholderia mallei (glanders)

Streptomycin + tetracycline3

Chloramphenicol + streptomycin

Burkholderia pseudomallei (melioidosis)

Ceftazidime

Tetracycline,3 TMP-SMZ,4 amoxicillin-clavulanic acid, imipenem or meropenem

Campylobacter jejuni

Azithromycin

A fluoroquinolone1

Enterobacter

Ertapenem, ...

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