From the Guidelines
For tooth infections where Augmentin is not an option, Clindamycin is a recommended alternative, given its ability to penetrate bone and cover most oral bacteria, with a dosage of 300-450mg every 6-8 hours for 7-10 days 1. When considering alternatives to Augmentin for tooth infections, several factors such as the severity of the infection, patient allergy history, and local resistance patterns must be taken into account.
- Clindamycin is particularly useful for patients allergic to penicillin, as it provides effective coverage against a wide range of oral pathogens, including those involved in dental infections 1.
- Azithromycin, with its convenient dosing regimen (500mg on day 1, then 250mg daily for 4 days), is another option but should be used cautiously due to increasing concerns about antibiotic resistance 1.
- Metronidazole (500mg every 8 hours for 7-10 days) is effective against anaerobic infections, which are common in dental infections, but it is often used in combination with another antibiotic to ensure broad coverage 1.
- Doxycycline (100mg twice daily for 7-10 days) offers broad-spectrum coverage and has the added benefit of anti-inflammatory properties, making it a viable option for some patients 1.
- In severe cases or where other options are not suitable, fluoroquinolones like levofloxacin may be considered, though their use is typically reserved for complicated infections due to concerns about resistance and side effects 1. It's crucial to note that while antibiotics are essential for treating bacterial infections, they do not replace the need for dental intervention, such as drainage or extraction, which may be necessary to fully resolve the infection. Therefore, regardless of the antibiotic chosen, follow-up with a dental professional is essential to ensure proper management of the infection and to prevent potential complications.
From the FDA Drug Label
Protocol 3: In another controlled comparative clinical and microbiologic study of otitis media performed in the United States, azithromycin was compared to amoxicillin/clavulanate potassium (4:1). Protocol 4: In a double-blind, controlled, randomized clinical study of acute otitis media in pediatric patients from 6 months to 12 years of age, azithromycin (10 mg/kg per day for 3 days) was compared to amoxicillin/clavulanate potassium (7:1) in divided doses q12h for 10 days Protocol 5: A double blind, controlled, randomized trial was performed at nine clinical centers Pediatric patients from 6 months to 12 years of age were randomized 1:1 to treatment with either azithromycin (given at 30 mg/kg as a single dose on Day 1) or amoxicillin/clavulanate potassium (7:1), divided q12h for 10 days.
Alternative antibiotics to Augmentin for a tooth infection may include Azithromycin, as it has been compared to amoxicillin/clavulanate potassium in several studies 2.
- Key points:
- Azithromycin has been shown to be effective in treating various bacterial infections, including those caused by S. pneumoniae, H. influenzae, and M. catarrhalis.
- The clinical success rate of azithromycin was comparable to that of amoxicillin/clavulanate potassium in several studies.
- Azithromycin may be considered as an alternative to Augmentin for tooth infections, especially in cases where the patient is allergic to penicillin or has experienced adverse effects with amoxicillin/clavulanate potassium.
From the Research
Alternative Antibiotics to Augmentin for Tooth Infection
- Amoxicillin/clavulanate (Augmentin) is commonly used to treat tooth infections, but alternative antibiotics can be used in certain situations 3, 4.
- For patients allergic to penicillin, clindamycin (Dalacin) is a preferred alternative 3, 5.
- Other alternative antibiotics include:
- Penicillin G or penicillin V (Rafapen) as first-line systemic antimicrobial agents 3.
- Cefuroxime (Zinnat) or penicillin and metronidazole as second-line regimens 3.
- Metronidazole, which can be used alone or in combination with penicillin or amoxicillin 3, 4.
- Tetracycline, which can be used in cases of aggressive periodontitis or acute necrotizing ulcerative gingivitis 3, 6.
- Macrolides, such as erythromycin, which can be used in patients allergic to penicillin 3, 6.
- Clindamycin, which has been shown to be a safe and effective alternative to ampicillin in the treatment of odontogenic infections 5.
Considerations for Antibiotic Selection
- The choice of antibiotic should be based on the severity of the infection, the patient's medical history, and the likelihood of antibiotic resistance 4, 7.
- It is essential to consider the potential for adverse reactions and superinfections when selecting an antibiotic 6.
- The use of broad-spectrum antibiotics should be reserved for severe infections or when other antibiotics are not effective 4, 7.