From the Guidelines
For dental infections unresponsive to Augmentin, Clindamycin is the most appropriate alternative antibiotic, typically prescribed at 300mg three times daily for 7-10 days, as it works well against anaerobic bacteria commonly found in dental infections and is effective when beta-lactam antibiotics fail 1.
Key Considerations
- The choice of antibiotic should be based on the severity of infection, patient allergies, and local resistance patterns.
- Clindamycin is a bacteriostatic antibiotic that is effective against a wide range of bacteria, including anaerobic bacteria that are commonly found in dental infections.
- Metronidazole combined with penicillin V is another option, with metronidazole dosed at 500mg three times daily and penicillin V at 500mg four times daily for 7-10 days, which targets both aerobic and anaerobic bacteria.
- For patients with severe infections or those who haven't responded to other treatments, azithromycin (500mg on day one, then 250mg daily for 4 days) or doxycycline (100mg twice daily for 7-10 days) may be used, particularly for patients with true penicillin allergies.
Important Points to Note
- Patients should complete the full course of treatment even if symptoms improve.
- Patients should seek immediate medical attention if the infection worsens or spreads despite antibiotic therapy.
- The most recent and highest quality study, published in 2014, provides guidance on the diagnosis and management of skin and soft tissue infections, including dental infections 1.
Antibiotic Options
- Clindamycin: 300mg three times daily for 7-10 days
- Metronidazole + Penicillin V: 500mg three times daily + 500mg four times daily for 7-10 days
- Azithromycin: 500mg on day one, then 250mg daily for 4 days
- Doxycycline: 100mg twice daily for 7-10 days
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 Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin The patient can be given clindamycin as an alternative antibiotic for a dental infection unresponsive to Augmentin, considering the patient's situation and the fact that clindamycin is effective against a wide range of bacteria, including anaerobes, streptococci, pneumococci, and staphylococci 2.
- Key considerations:
- The patient's allergy status to penicillin should be assessed before prescribing clindamycin.
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
- Clindamycin should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
From the Research
Alternative Antibiotics for Dental Infections
The patient has already been given Augmentin (amoxicillin/clavulanate) for 7 days with no relief, and an appointment with a dentist is scheduled in 1 week. Considering the lack of response to Augmentin, alternative antibiotics may be necessary.
- Clindamycin: A study published in 2015 3 compared the efficacy of amoxicillin/clavulanic acid to clindamycin in treating odontogenic infections and found that clindamycin was comparable to amoxicillin/clavulanic acid in achieving clinical success.
- Metronidazole: Research from 2007 4 showed that metronidazole, along with amoxicillin/clavulanic acid and clindamycin, exhibited high antimicrobial activity against anaerobic bacteria involved in dentoalveolar infections.
- Other options: Although not directly studied in the context of dental infections, a 2020 review 5 discussed the potential of antibiotic combination therapy in combating resistant bacterial infections, which might be relevant in cases where standard treatments fail.
Considerations for Antibiotic Choice
When selecting an alternative antibiotic, it's essential to consider the patient's specific infection, potential allergies, and the antibiotic's spectrum of activity.
- Antimicrobial susceptibility: The 2007 study 4 highlighted the importance of understanding the antimicrobial susceptibility of anaerobic pathogens involved in dentoalveolar infections to guide antibiotic selection.
- Resistance patterns: A 2020 narrative review 6 emphasized the need for careful consideration of antibiotic usage to minimize the development of resistance, which is crucial in the treatment of dental infections.
Next Steps
Given the patient's lack of response to Augmentin and the upcoming dentist appointment, it may be necessary to consider alternative antibiotics, such as clindamycin or metronidazole, until the patient can be evaluated by a dentist. However, the final decision should be based on the patient's specific condition, medical history, and the dentist's professional assessment.