From the Guidelines
For patients with a penicillin allergy who have an odontogenic infection, clindamycin is typically the recommended alternative antibiotic, with a dosage of 7 mg per kg per dose three times daily (maximum = 300 mg per dose) for 10 days, as recommended by the IDSA guideline update 1. This recommendation is based on the strong, moderate evidence from the IDSA guideline update, which suggests that clindamycin is effective against most oral bacteria responsible for dental infections.
- Clindamycin has good penetration into bone and soft tissues, making it suitable for treating dental abscesses.
- It is generally well-tolerated by patients with penicillin allergies.
- However, before starting treatment, it is essential to ensure the patient is not allergic to clindamycin as well. Some alternative options, such as azithromycin or clarithromycin, may be considered, but these should be prescribed in consultation with a dentist or physician, as recommended by the IDSA guideline update 1. Patients should complete the full course of antibiotics even if symptoms improve, and they should be advised to seek immediate medical attention if they develop severe diarrhea, as clindamycin can occasionally cause C. difficile infection, as noted in the clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer 1. It is also important to remember that while antibiotics can help control the infection, definitive treatment often requires dental procedures to address the underlying cause of the infection.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of colitis, as described in the BOXED WARNING, before selecting clindamycin, the physician should consider the nature of the infection and the suitability of less toxic alternatives (e.g., erythromycin)
Alternative to Penicillin: Clindamycin is an alternative to penicillin for treating odontogenic infections in patients with a penicillin allergy, as it is effective against susceptible anaerobic bacteria, streptococci, pneumococci, and staphylococci.
- Key considerations: The physician should consider the nature of the infection and the suitability of less toxic alternatives, such as erythromycin, before selecting clindamycin 2.
- Important note: Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
From the Research
Alternatives to Penicillin for Odontogenic Infection
In patients with a penicillin allergy, alternative antibiotics can be used to treat odontogenic infections.
- For patients with unknown or possible penicillin allergy, or those with a drug fever or rash, beta-lactam antibiotics may be used safely 3.
- However, for patients with hives or anaphylactic reactions, penicillins or beta-lactams should not be used, and antimicrobial therapy with an antibiotic that does not cross-react with penicillins or beta-lactams should be considered 3.
- Cephalosporins are a relatively safe treatment option for patients with a low risk of severe allergic reactions, as only 1-2% of patients with a confirmed penicillin allergy have an allergy to cephalosporins 4.
Considerations for Antibiotic Selection
When selecting an alternative antibiotic, it is essential to consider the patient's allergy history and the severity of the reaction.
- A systematic approach, including medical record review and patient interview, can help differentiate adverse drug reactions from antibiotic allergies 5.
- In some cases, patients with a history of delayed non-severe reactions may be suitable for an oral rechallenge with low-dose penicillin in a supervised hospital environment 4.
- Removing the penicillin allergy label may be possible with appropriate assessment and allergy testing, allowing for the use of penicillin or other beta-lactam antibiotics 4.