A review article in the Annals of Internal Medicine has concluded that the gram-negative anaerobe Fusobacterium necrophorum is as common as group A strep in teenagers with sore throats.
Up to 1 in 400 of these cases develop complications, such as abscess formation, septicaemia with septic pulmonary emboli, and Lemierre syndrome (septic thrombophlebitis of the internal jugular vein). The death rate has been reported to be as high as 5%.
Penicillin or a cephalosporin is the treatment of choice, and clindamycin is added if there is evidence of sepsis or neck swelling or used as the primary agent if the patient is allergic to penicillin. F. necrophorum is not sensitive to macrolides, author Robert A. Centor concluded.
SOURCE: Ann Intern Med 2009;151:812.
Editor Dr Ramesh Manocha