From the Guidelines
The best medication for dental infections is typically amoxicillin, prescribed at 500mg three times daily for 5 days, as recommended by the Medecins sans frontieres guideline for dental infections 1. For patients allergic to penicillin, clindamycin (300mg four times daily) or azithromycin (500mg on day one, then 250mg daily for 4 days) are effective alternatives. These antibiotics work by either killing bacteria or preventing their reproduction, addressing the infection at its source. However, antibiotics should always be combined with proper dental treatment, as they cannot resolve the underlying cause alone. Dental infections often require professional intervention such as drainage, root canal therapy, or tooth extraction to eliminate the source of infection. Some key points to consider when treating dental infections include:
- The use of antibiotics should be based on the severity of the infection and the patient's medical history 1.
- The choice of antibiotic should be guided by the suspected or confirmed causative organism and local resistance patterns 1.
- The duration of antibiotic treatment should be as short as possible to minimize the risk of antibiotic resistance and side effects 1. Pain management with over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help with discomfort while the antibiotics work. It's crucial to complete the entire course of antibiotics even if symptoms improve to prevent antibiotic resistance and ensure complete eradication of the infection. In cases where the infection is severe or the patient has a compromised immune system, hospitalization and intravenous antibiotic therapy may be necessary 1. The use of antibiotics in dental infections should always be guided by the principles of antimicrobial stewardship to minimize the risk of antibiotic resistance and promote optimal patient outcomes.
From the Research
Medications for Dental Infections
The most effective medications for dental infections are:
- Metronidazole
- Carbapenems (imipenem, meropenem, doripenem, ertapenem)
- Combinations of a penicillin and a beta-lactamase inhibitor (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, piperacillin plus tazobactam)
- Tigecycline
- Cefoxitin
- Clindamycin 2, 3
Oral Antibiotics for Acute Dentoalveolar Infections
Oral antibiotics used to manage acute dentoalveolar infections include:
- Amoxicillin
- Amoxicillin/clavulanic acid
- Cefalexin
- Clindamycin
- Erythromycin
- Metronidazole
- Moxifloxacin
- Ornidazole
- Phenoxymethylpenicillin 4
Choice of Antibiotic
The ideal choice of antibiotic for dental infections is unclear, but narrow-spectrum agents appear to be as effective as broad-spectrum antibiotics in otherwise healthy individuals 4