From the FDA Drug Label
Amoxicillin has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections [see Indications and Usage (1)] Gram-Positive Bacteria Enterococcus faecalis Staphylococcusspp. Streptococcus pneumoniae Streptococcusspp (alpha and beta-hemolytic) Gram-Negative Bacteria Escherichia coli Haemophilus influenzae Helicobacter pylori Proteus mirabilis
The patient should be discharged with amoxicillin (PO) 1, as it is effective against a broad spectrum of bacteria that may be causing the infection.
- Dosage: Not specified in the provided drug label, but it should be determined based on the severity of the infection and the patient's medical history.
- Precautions: The patient should be monitored for signs of allergic reactions, and the antibiotic should be used only for the prescribed duration to minimize the risk of resistance. However, for a periapical cystic lesion with possible abscess formation, clindamycin (PO) 2 may also be considered, especially if the patient is allergic to penicillin or if the infection is caused by anaerobic bacteria.
- Dosage: Not specified in the provided drug label, but it should be determined based on the severity of the infection and the patient's medical history.
- Precautions: The patient should be monitored for signs of colitis and other adverse reactions, and the antibiotic should be used only for the prescribed duration to minimize the risk of resistance.
From the Research
For a periapical cystic lesion in the right maxilla with signs of superinfection and possible abscess formation, I recommend amoxicillin-clavulanate (Augmentin) 875/125 mg taken orally twice daily for 7-10 days, as it is effective against the mixed aerobic and anaerobic bacteria typically found in odontogenic infections, as suggested by the most recent and highest quality study 3. The use of antibiotics in this scenario is supported by the evidence, which suggests that antibiotics may provide benefits in cases of systemic involvement or high risk of progression to systemic involvement 3. However, it is essential to note that the evidence also highlights the potential harms associated with antibiotic use, including the development of antibiotic resistance 4, 5. The patient should be advised to seek prompt dental care, as definitive treatment requires dental intervention to address the source of infection, typically involving either root canal therapy or extraction of the affected tooth 5, 3. Additionally, the patient should maintain good oral hygiene, use warm salt water rinses, and take over-the-counter pain medications as needed for symptom management while awaiting definitive treatment. If the patient has a penicillin allergy, clindamycin 300 mg taken orally four times daily for 7-10 days would be an alternative option, as it is also effective against the bacteria commonly found in odontogenic infections 6. It is crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to use antibiotics judiciously and only when necessary, as emphasized by the American Dental Association's clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling 3.