From the Guidelines
For odontogenic infections, the first-line antibiotic treatment is amoxicillin-clavulanate 875/125 mg bid po, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection and the patient's allergy history.
- For patients with penicillin allergy, clindamycin 300-400 mg qid po is a suitable alternative 1.
- In cases of methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin 30 mg/kg/d in 2 divided doses IV or linezolid 600 mg every 12 h IV or 600 mg bid po may be considered 1.
Antibiotic Options
- Amoxicillin-clavulanate: 875/125 mg bid po for adults, 25 mg/kg/d of the amoxicillin component in 2 divided doses po for children 1.
- Clindamycin: 300-400 mg qid po for adults, 20 mg/kg/d in 3 divided doses po for children 1.
- Vancomycin: 30 mg/kg/d in 2 divided doses IV for adults, 40 mg/kg/d in 4 divided doses IV for children 1.
- Linezolid: 600 mg every 12 h IV or 600 mg bid po for adults, 10 mg/kg every 12 h IV or po for children <12 y 1.
Important Notes
- Antibiotic treatment should always be accompanied by appropriate dental intervention, as antibiotics alone are insufficient for definitive treatment of odontogenic infections.
- Patients should complete the full course of antibiotics even if symptoms improve to prevent recurrence and antibiotic resistance.
- The choice of antibiotic and dosage should be guided by the most recent and highest-quality evidence, such as the 2014 update by the Infectious Diseases Society of America 1.
From the FDA Drug Label
Adults: Serious infections – 150 to 300 mg every 6 hours. More severe infections – 300 to 450 mg every 6 hours Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses. More severe infections – 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses. Table 1 ... Ear/Nose/Throat Skin/Skin Structure Genitourinary Tract Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
Antibiotic options for odontogenic infections include:
- Amoxicillin (PO):
- Adults: 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections, 875 mg every 12 hours or 500 mg every 8 hours for severe infections
- Pediatric patients: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for mild/moderate infections
- Clindamycin (PO):
- Adults: 150 to 300 mg every 6 hours for serious infections, 300 to 450 mg every 6 hours for more severe infections
- Pediatric patients: 8 to 16 mg/kg/day divided into three or four equal doses for serious infections, 16 to 20 mg/kg/day divided into three or four equal doses for more severe infections 2 3
From the Research
Antibiotic Options for Odontogenic Infections
The following antibiotics are commonly used to treat odontogenic infections:
- Penicillin V (phenoxymethyl penicillin) is the antimicrobial of choice for the initial empirical treatment of odontogenic infections 4
- Amoxicillin is recommended for endocarditis prophylaxis and can be used in combination with clavulanic acid for the treatment of odontogenic infections 5, 6
- Erythromycin may be used for mild, acute odontogenic infections in penicillin-allergic patients 4
- Clindamycin is effective against all odontogenic pathogens, but its potential gastrointestinal toxicity limits its use to third- or fourth-line therapy 4, 6, 7
- Metronidazole displays excellent activity against anaerobic gram-negative bacilli, but should not be used alone in the treatment of acute odontogenic infections 4, 6
Dosing and Pharmacokinetics
The dosing and pharmacokinetics of antibiotics play a crucial role in their effectiveness against odontogenic infections:
- Amoxicillin/clavulanic acid is recommended due to its wide spectrum, low incidence of resistance, pharmacokinetic profile, tolerance, and dosage 5
- Co-amoxiclav (80 mg/kg/day) obtained adequate efficacy indexes against all microorganisms examined, except for Veillonella spp. 6
- Clindamycin (40 mg/kg/day) obtained adequate PK/PD indexes, except for Lactobacillus, Actinobacillus actinomycetemcomitans, penicillin-resistant Peptostreptococcus, and Eikenella corrodens 6
- High-dose amoxicillin yielded unsatisfactory results against many bacterial species 6
Antibiotic Resistance
Antibiotic resistance is a significant concern in the treatment of odontogenic infections:
- Staphylococcus aureus, Streptococcus viridans, Klebsiella pneumoniae, and other species have shown high levels of resistance to various antibiotics 8
- Peptostreptococcus spp., Bacteroides spp., and Prevotella spp. have also exhibited resistance to multiple antibiotics 8
- Clindamycin-treated patients had a higher rate of treatment failure and isolated organisms resistant to clindamycin 7