What is the Unasyn (Ampicillin-Sulbactam) regimen for a 9-year-old female with a new facial abscess of likely odontogenic origin?

From the Guidelines

For a 9-year-old female with a new facial abscess that is likely odontogenic, the recommended Unasyn (ampicillin/sulbactam) regimen is 100-200 mg/kg/day of the ampicillin component, divided into 4 doses, administered intravenously, as this provides coverage against the mixed aerobic and anaerobic oral flora typically involved, including streptococci, oral anaerobes, and beta-lactamase producing organisms 1.

Key Considerations

• The sulbactam component helps overcome resistance from beta-lactamase producing bacteria.
• For a typical 9-year-old weighing approximately 28 kg, this would translate to about 700-1400 mg of ampicillin component (or 1050-2100 mg of Unasyn) per dose, given every 6 hours.
• Treatment duration is typically 7-10 days, depending on clinical response.
• The child should be monitored for improvement within 48-72 hours, with consideration for surgical drainage if there is no improvement.

Additional Recommendations

• Once clinical improvement is noted and the patient can tolerate oral medications, consider transitioning to an appropriate oral antibiotic such as amoxicillin-clavulanate to complete the treatment course.
• Ensure adequate pain management and encourage good oral hygiene during treatment.
• Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Unasyn Regimen for Odontogenic Facial Abscess

• The Unasyn regimen, which is a combination of ampicillin and sulbactam, is effective in treating odontogenic infections, including facial abscesses 2.
• According to a study published in 2007, patients with facial cellulitis of odontogenic origin were randomized to receive either intravenous ampicillin/sulbactam or clindamycin for 48 hours, followed by oral amoxicillin/clavulanate or clindamycin for 7 days 2.
• The study found that both treatment regimens were effective, with no treatment failures in either group, suggesting that Unasyn can be a suitable option for treating odontogenic facial abscesses in children 2.
• Another study published in 2020 found that clindamycin was more commonly used than penicillin-based antibiotics, including Unasyn, in the treatment of facial cellulitis of odontogenic origin in children 3.
• However, the 2007 study suggests that Unasyn can be an effective alternative to clindamycin in the treatment of odontogenic infections 2.

Dosage and Administration

• The dosage and administration of Unasyn for a 9-year-old female with a new facial abscess that is likely odontogenic would depend on the severity of the infection and the patient's weight and medical history.
• According to the 2007 study, patients received intravenous ampicillin/sulbactam for 48 hours, followed by oral amoxicillin/clavulanate for 7 days 2.
• The exact dosage and administration of Unasyn for this patient would need to be determined by a healthcare professional, taking into account the patient's individual needs and medical history.

Efficacy and Safety

• The efficacy and safety of Unasyn in treating odontogenic facial abscesses in children have been demonstrated in several studies 2, 4.
• A study published in 2009 found that ampicillin, a component of Unasyn, was effective in reducing the time of clinical symptoms of acute odontogenic abscess in patients who received surgical treatment 4.
• However, the safety and efficacy of Unasyn in children would need to be carefully monitored by a healthcare professional, taking into account the patient's individual needs and medical history.