Pelvic actinomycosis - Is long-term antibiotic therapy necessary?

OBJECTIVE: To describe II cases of actinomycosis and analyze whether long-t erm antibiotic use is necessary. STUDY DESIGN: Analysis of II cases of pelvic actinomycosis diagnosed and tr eated during the last nine years. Four patients had an intrauterine device (IUD) for 6-20 years, three patients had an IUD for 3-5 years, and four pat ients had no known etiology. In most patients the symptoms lasted from seve ral days to one month. The actinomycotic lesions involved one or both ovari es in all 11 cases. In five patients the lesion extended to other areas, su ch as the uterus, omentum, parametrium, pelvic walls, colon, bladder, cul-d e-sac and gallbladder. RESULTS: All patients underwent surgery that included removal of the lesion s with the ipsilateral or both adnexa and, in specific cases, with extensio n of the lesions, hysterectomy, omentectomy, hemicolectomy and cholecystect omy. Confirmation of the diagnosis of actinomycosis was done by histology i n all cases, and antibiotic treatment usually began 1-14 days after surgery . The drug of choice was penicillin. The duration of treatment was 12 month s in 6 patients, 6 months in 3 and less than or equal to 3 months in two. A ll patients were alive and well after two to nine years of follow-up. CONCLUSION: In contrast to actinomycosis at other sites, where the literatu re recommends antibiotic therapy for 6-12 months, pelvic actinomycosis coul d be a limited disease. We propose that in cases of pelvic actinomycosis wh ere the abscess can be completely removed surgically, a shorter period of a ntibiotic therapy can be effective.