Tooth infections from cavities, gingivitis, and periodontitis. Common symptoms include severe pain, tooth sensitivity, and inflammation of the face and gums. Most infections are polymicrobial and include anaerobic bacteria.
|Preferred antibiotic choice(s)|
|Amoxicillin-clavulanic acid (PO)||Oral liquid: 125 mg amoxicillin + 31.25 mg clavulanic acid/5 mL AND 250 mg amoxicillin + 62.5 mg clavulanic acid/5 mL; Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt)||
500 mg component of amoxicillin 8 hourly
|3 days if adequate source control, or 5 days if not|
|Phenoxymethyl-penicillin (penicillin V) (PO)||Powder for oral liquid: 250 mg (as potassium salt)/5 mL; Tablet: 250 mg (as potassium salt)||500 mg 6 hourly||3 days if adequate source control, or 5 days if not|
|In case of confirmed drug allergy or medical contraindication|
|Combination therapy with:
|Azithromycin- Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL||500 mg 6 hourly||5 days|
|Metronidazole- Oral liquid: 200 mg (as benzoate)/ 5 mL; Tablet: 200 mg to 500 mg||400 mg 8 hourly|
Principles of Stewardship:
- Dental abscess requires surgical drainage, not just antibiotics.
- If the abscess is drained and the patient is improving, consider stopping antibiotics after 3 days of treatment.
- Although gingivitis is a risk factor for dental abscess, only acute necrotizing gingivitis should be treated with antibiotics.
- For gingivitis without necrosis or abscess, do not treat with antibiotics.
- For acute necrotizing gingivitis:
- Treat with clindamycin [Dosage: Capsule: 150 mg (as hydrochloride); Injection: 150 mg (as phosphate)/ mL; Oral liquid: 75 mg/5 mL (as palmitate)] for 3 days.
- For cases of acute necrotizing gingivitis associated with malnutrition, treat with vitamins.