Cervicofacial Actinomycosis Without Penicillin Allergy: When First-Line Therapy Does Not Achieve Clinical Improvement

The standard first step in penicillin-tolerant patients is a surgical intervention — incision and drainage of the swelling, with debridement of necrotic tissue when needed — combined with intravenous penicillin G and metronidazol, followed by a course of oral penicillin V.

Escalation to this protocol is indicated when clinical improvement is not achieved on that regimen. The expected window for clinical response can range from 1 to 46 days; failure to improve within this period warrants a change in treatment.