Davanos Evangelia, Rahman Shafiqur M, Nogid Boris
Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA.
Ann Pharmacother. 2008 Nov;42(11):1706-10. doi: 10.1345/aph.1L257. Epub 2008 Oct 14.
To report a case of Eikenella corrodens and Actinomyces odontolyticus foot abscess secondary to a toothpick puncture in a penicillin-allergic patient that was successfully treated with a long-term course of doxycycline.
A 39-year-old woman with diabetes mellitus type 2 and hyperlipidemia presented with difficulty ambulating as well as pain and swelling of her right foot. Prior to presentation, she sustained a toothpick puncture to her right foot; she removed the toothpick intact and did not know whether it had been used. Due to a penicillin allergy, she began treatment with levofloxacin, which was changed to clindamycin one day later. The patient was diagnosed with right Achilles tendonitis/cellulitis and was discharged on a one-week course of clindamycin. Twenty-five days later she was readmitted, complaining of pain and swelling in the same area, which this time presented as an abscess. Upon this admission, vancomycin and levofloxacin were initiated and incision and drainage (I & D) was performed. Cultures and sensitivities from I & D were significant for E. corrodens and A. odontolyticus, and treatment was changed to intravenous doxycycline 100 mg every 12 hours for 10 weeks. Oral doxycycline 100 mg every 12 hours was then used for 3 months, and treatment was successful.
E. corrodens and A. odontolyticus are 2 slow-growing organisms that are part of the normal oropharyngeal flora. Extraoral infections due to either of these organisms may be difficult to treat and might need lengthier treatments than are necessary for most infections. First-line treatment for such infections is penicillins and cephalosporins; however, in a patient with penicillin allergy, treatment options become limited, as there is potential cross-reactivity with other agents.
Patients with infections secondary to E. corrodens and/or A. odontolyticus in whom penicillin allergy is a concern can be treated effectively with doxycycline.
报告1例青霉素过敏患者因牙签刺伤继发腐蚀埃肯菌和溶齿放线菌足部脓肿，经长期多西环素治疗成功治愈的病例。
一名患有2型糖尿病和高脂血症的39岁女性，出现行走困难以及右脚疼痛和肿胀。就诊前，她右脚被牙签刺伤；她完整地取出了牙签，不知道牙签是否被使用过。由于对青霉素过敏，她开始使用左氧氟沙星治疗，一天后改为克林霉素。患者被诊断为右跟腱炎/蜂窝织炎，并接受了为期一周的克林霉素治疗后出院。25天后，她再次入院，主诉同一部位疼痛和肿胀，此次表现为脓肿。此次入院后，开始使用万古霉素和左氧氟沙星，并进行了切开引流术（I&D）。切开引流术的培养和药敏结果显示腐蚀埃肯菌和溶齿放线菌感染，治疗改为每12小时静脉注射100mg多西环素，持续10周。随后每12小时口服100mg多西环素，持续3个月，治疗成功。
腐蚀埃肯菌和溶齿放线菌是2种生长缓慢的微生物，是正常口咽菌群的一部分。由这两种微生物引起的口外感染可能难以治疗，可能需要比大多数感染更长时间的治疗。此类感染的一线治疗药物是青霉素和头孢菌素；然而，对于青霉素过敏的患者，治疗选择变得有限，因为与其他药物存在潜在交叉反应。
对于有青霉素过敏问题的腐蚀埃肯菌和/或溶齿放线菌继发感染患者，多西环素可有效治疗。
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