Initial therapy should include intravenous penicillin G or ampicillin for 4 to 6 weeks followed by high doses of oral penicillin (up to 2 g/day for adults) for a total of 6 to 12 months. Amoxicillin, erythromycin, clindamycin, doxycycline, and tetracycline are alternative antimicrobial choices. Tetracyclines are not recommended for pregnant women or children younger than 8 years of age. Surgical drainage often is a necessary adjunct to medical management and may allow for a shorter duration of antimicrobial Treatment.