From the Guidelines
For a 15-year-old with a dental infection who is allergic to amoxicillin, Cephalexin is a recommended alternative antibiotic, with a dosage of 20 mg per kg per dose twice daily (maximum = 500 mg per dose) for 10 days, as per the guidelines 1. The choice of antibiotic is crucial in managing dental infections, especially in patients allergic to amoxicillin. Considering the patient's age and allergy, it's essential to select an antibiotic that is effective against the common bacteria causing dental infections.
- Cephalexin is a suitable option, given its strong recommendation and high-quality evidence for patients with penicillin allergy 1.
- Other alternatives like Clindamycin, Azithromycin, and Clarithromycin may also be considered, but Cephalexin is preferred due to its stronger recommendation and higher quality of evidence 1. It's vital to complete the full course of antibiotics, even if symptoms improve before finishing the medication, to ensure the infection is fully cleared. Additionally, the patient should be advised to take over-the-counter pain relievers like ibuprofen for discomfort, maintain good oral hygiene, and follow up with a dentist promptly, as antibiotics alone won't resolve the underlying dental issue.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
- Clindamycin can be considered for a 15-year-old with a teeth infection who is allergic to amoxicillin, as it is indicated for serious infections caused by susceptible anaerobic bacteria, streptococci, pneumococci, and staphylococci.
- However, bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
- The use of clindamycin should be reserved for patients who are allergic to penicillin or for whom a penicillin is inappropriate, as stated in the drug label 2.
From the Research
Antibiotic Options for a 15-year-old with a Teeth Infection Allergic to Amoxicillin
- The patient is allergic to amoxicillin, so alternative antibiotics must be considered 3, 4.
- For mild, acute odontogenic infections in penicillin-allergic patients, erythromycin may be used 3.
- Tetracycline may be considered as an alternative therapy for penicillin-allergic patients over the age of 13 who cannot tolerate erythromycin 3.
- Clindamycin is very effective against all odontogenic pathogens, but its potential gastrointestinal toxicity relegates it to third- or even fourth-line therapy in general dentistry 3.
- Co-amoxiclav (80 mg/kg/day) obtained adequate efficacy indexes against all the microorganisms examined, with the exception of Veillonella spp. 5.
- Clindamycin (40 mg/kg/day) obtained adequate PK/PD indexes except for Lactobacillus, Actinobacillus actinomycetemcomitans, penicillin-resistant Peptostreptococcus, and Eikenella corrodens 5.
Considerations for Antibiotic Therapy
- Antibiotic therapy should only be used when systemic involvement is clear and should be limited to monotherapy with β-lactams in the first instance 6.
- Metronidazole does not provide superior clinical outcomes (alone or in combination with a β-lactam) when compared with a β-lactam antibiotic alone for the treatment of non-periodontal dental infections in general dental practice 6.
- Guidelines should reinforce the importance of surgical interventions and if appropriate the use of a single agent narrow-spectrum β-lactam 6.