From the FDA Drug Label
INDICATIONS AND USAGE Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Anaerobes: Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess; serious skin and soft tissue infections; septicemia; intra- abdominal infections such as peritonitis and intra-abdominal abscess Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
The choice of antibiotic for a dental abscess is not directly stated in the provided drug labels. However, clindamycin is indicated for the treatment of serious infections caused by susceptible anaerobic bacteria, which may be present in dental abscesses.
- Key points:
- Clindamycin is effective against anaerobic bacteria.
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin. Given the information provided, clindamycin may be considered for the treatment of dental abscesses caused by susceptible anaerobic bacteria, but only after bacteriologic studies have been performed to confirm susceptibility 1.
From the Research
For a dental abscess, the use of antibiotics should be reserved for cases with systemic involvement, such as malaise or fever, and immediate dental intervention, like drainage or root canal therapy, should be prioritized. The choice of antibiotic, when necessary, is typically amoxicillin 500 mg three times daily for 5-7 days, as it targets the common bacteria found in dental infections, which are typically mixed aerobic and anaerobic organisms 2. If the patient is allergic to penicillin, clindamycin 300 mg four times daily for 5-7 days is an appropriate alternative. For more severe infections or in cases with spreading infection, amoxicillin with clavulanic acid (Augmentin) 875/125 mg twice daily for 7 days may be preferred, as shown in a study comparing its efficacy and tolerability to clindamycin 3.
It's crucial to note that antibiotics should complement, not replace, appropriate dental intervention. Pain management with acetaminophen or ibuprofen is also recommended. Patients should complete the full course of antibiotics even if symptoms improve before completion. The American Dental Association recommends against using antibiotics in most clinical scenarios, irrespective of the availability of definitive, conservative dental treatment, due to the potential for negligible benefits and large harms 4.
Key considerations include:
- The importance of dental intervention as the primary treatment for dental abscesses
- The potential for antibiotics to contribute to bacterial resistance and other adverse effects
- The need for careful selection of patients who would benefit from antibiotic therapy, based on the presence of systemic involvement or high risk of progression to systemic involvement
- The recommendation for narrow-spectrum agents as first-line empirical therapy in otherwise healthy individuals, as broad-spectrum antibiotics are often unnecessary 2.
If symptoms worsen or don't improve within 48-72 hours, the patient should seek immediate follow-up care, as this may indicate a need for different antibiotics or additional interventions.