What antibiotics are used to treat dental (tooth) infections?

From the Guidelines

Antibiotics should only be used for tooth infections when there is evidence of systemic involvement, such as fever, lymphadenopathy, or cellulitis, and surgical drainage is not possible, with amoxicillin (500mg three times daily for 7-10 days) or clindamycin (300mg four times daily for 7 days) being suitable options 1. The primary treatment for tooth infections, such as acute dental abscesses, is surgical, including root canal therapy or extraction of the tooth, as recommended by the M edecins sans fronti eres e Dental infections guideline 1. Some key points to consider when prescribing antibiotics for tooth infections include:

• The European Society of Endodontology recommends not using antibiotics in patients with acute apical periodontitis and acute apical abscesses, instead opting for surgical drainage 1.
• The American Dental Association suggests using systemic sub-antimicrobial dose doxycycline as an adjunct to scaling and root planning for chronic periodontitis, but not for acute tooth infections 1.
• The Scottish Dental Clinical Effectiveness Programme advises against using antimicrobials for chronic periodontitis or peri-implantitis 1. While taking antibiotics, it's essential to complete the entire course, even if symptoms improve, take them with food to reduce stomach upset, and avoid alcohol 1. Additionally, pain relievers like ibuprofen or acetaminophen can help manage discomfort while waiting for dental care 1. It's crucial to note that antibiotics alone are not sufficient treatment for dental infections, and professional dental treatment remains essential to address the underlying cause of the infection, such as decay reaching the tooth pulp, which typically requires dental procedures like root canal treatment or extraction 1.

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 staphylococci 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 Streptococci: Serious respiratory tract infections; serious skin and soft tissue infections. Staphylococci: Serious respiratory tract infections; serious skin and soft tissue infections. Pneumococci: Serious respiratory tract infections

Tooth Infection Treatment The FDA drug label for clindamycin 2 does not explicitly mention tooth infections. However, it does mention serious skin and soft tissue infections, which could potentially include dental infections. On the other hand, the FDA drug label for amoxicillin 3 does not explicitly mention tooth infections either, but it does mention Streptococcus and Staphylococcus species, which are commonly involved in dental infections. Given the information available, it is not possible to draw a conclusion about the use of these antibiotics for tooth infections.

From the Research

Antibiotics for Tooth Infection

• The microflora associated with odontogenic infections are typically mixed and of indigenous origin, including Streptococcus, peptostreptococcus, peptococcus, fusobacterium, bacteroides, and actinomyces species 4.
• Penicillin V (phenoxymethyl penicillin) remains the antimicrobial of choice for the initial empirical treatment of odontogenic infections, as it is safe, highly effective, and inexpensive 4, 5.
• Amoxicillin has little indication for the routine treatment of odontogenic infections, but it is the agent of choice for endocarditis prophylaxis, as it produces higher serum levels than penicillin V 4.
• Erythromycin may be used for mild, acute odontogenic infections in penicillin-allergic patients, while tetracycline may be considered as an alternative therapy for penicillin-allergic patients over the age of 13 who cannot tolerate erythromycin 4, 5.
• Clindamycin is very effective against all odontogenic pathogens, but its potential gastrointestinal toxicity relegates it to third- or even fourth-line therapy in general dentistry 4, 5.
• Metronidazole does not provide superior clinical outcomes (alone or in combination with a β-lactam) when compared with a β-lactam antibiotic alone for the treatment of non-periodontal dental infections in general dental practice 6.
• The management of dental infections through antimicrobial strategies has undergone significant advancements, with emerging technologies such as 3D printing for drug delivery of antibiotics and disinfectants holding promise in enhancing treatment efficacy and patient outcomes 7.
• Antibiotics should only be prescribed when systemic involvement is clear and should be limited to monotherapy with β-lactams in the first instance, with guidelines reinforcing the importance of surgical interventions and the use of a single agent narrow-spectrum β-lactam 6, 8.