No prospective randomized study has established efficacy of antimicrobial
treatment for A haemolyticum infection.1,3 In
infected patients without antibiotic therapy, symptoms can last
for a few days to more than 1 week. However, in antibiotic-treated
patients, symptoms last, on average, 3 days.8 In
vitro A haemolyticum is sensitive to erythromycin,
clindamycin, azithromycin, and vancomycin.2,3,12 The
organism has sensitivity to penicillin but some tolerance has been
demonstrated. A haemolyticum has shown some resistance
(30%) to tetracycline13,14 and is usually resistant
to sulfonamides and trimethoprim-sulfamethoxazole. Resistance to
ciprofloxacin was recently described in a case of brain abscess.10 Erythromycin
is the drug of choice.1,3,4,8 Bacteriologic failure
has occurred when penicillin was given to treat pharyngitis from
which A haemolyticum was cultured. Whereas pharyngitis due
to A haemolyticum has resolved in the untreated
patient, invasive disease caused by A haemolyticum can
be fatal. For invasive disease, intravenous beta-lactams (ie, penicillin,
ampicillin, cefotaxime) are recommended, but susceptibility testing
should be performed. Vancomycin should be effective; however, a
strain carrying the van A gene, and resistant to vancomycin, has been
identified.15 In disseminated disease, penicillin
plus an aminoglycoside given by parenteral route should be considered
empirically.3
Because the exact mechanism for human-to-human spread is unknown,
judicious hand washing and avoidance of sharing food and utensils
may be of benefit in limiting disease transmission.