What is the appropriate dosage of amoxicillin (amoxicillin) for an adult with a dental infection?

From the Guidelines

For adult dental infections, the recommended amoxicillin dosage is 875/125 mg twice daily, as indicated by the most recent and highest quality study available 1. This dosage is based on the guidelines for the diagnosis and management of skin and soft tissue infections, which include dental infections. The study suggests that amoxicillin-clavulanate at a dose of 875/125 mg bid po is effective for treating infections caused by Staphylococcus and Streptococcus species, which are common pathogens in dental infections. Some key points to consider when prescribing amoxicillin for dental infections include:

• The importance of completing the full course of antibiotics, even if symptoms improve before finishing
• The need to take amoxicillin with or without food, though taking it with food may help reduce stomach upset
• The importance of drinking plenty of water with each dose
• The fact that antibiotics should be used alongside proper dental treatment, not as a substitute for it
• The potential for dental infections to spread to other areas of the head and neck, and the need to seek immediate medical attention if symptoms worsen. It's also worth noting that for patients with penicillin allergy, alternatives such as clindamycin (300-400 mg qid po) may be considered, as suggested by the study 1. However, the primary recommendation for adult dental infections remains amoxicillin-clavulanate at a dose of 875/125 mg twice daily.

From the FDA Drug Label

In Adults, 750 to 1750 mg/day in divided doses every 8 to 12 hours

• The recommended dose of amoxicillin for adults is between 750 to 1750 mg/day in divided doses every 8 to 12 hours.
• For dental infections, the dose may vary, but the general adult dose range can be applied.
• It is essential to consult the full prescribing information for specific dosing regimens 2.

From the Research

Adult Amoxicillin Dosing for Dental Infection

• The recommended dosing of amoxicillin for dental infections is not explicitly stated in the provided studies, but a study from 2015 3 compared the efficacy of amoxicillin/clavulanic acid (875 mg/125 mg BID) to clindamycin (150 mg QID) for the treatment of odontogenic infections.
• Another study from 1997 4 prescribed amoxycillin (250 mg every 8 hours) to patients with acute dentoalveolar abscesses and found that the duration of antibiotic therapy can safely be 2-3 days, provided that drainage has been established.
• A 2019 guideline from the American Dental Association 5 recommends against using antibiotics in most clinical scenarios for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling, except in cases with systemic involvement or high risk of progression to systemic involvement.
• The choice of antibiotic and dosing regimen may depend on the specific condition being treated, as well as the patient's medical history and other factors, as discussed in a 2021 review of antibiotic therapy in dentistry 6.
• A 2024 systematic review 7 found that systemic antibiotics may not provide significant benefits for adults with symptomatic apical periodontitis or acute apical abscess, and that the evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localized apical abscess or symptomatic necrotic tooth.