From the Guidelines
For oral lesions in children, the most appropriate medication option is often topical analgesics, such as benzocaine or lidocaine, for pain relief, alongside antimicrobials like chlorhexidine gluconate for bacterial infections or nystatin for fungal infections. The choice of medication depends on the specific condition of the oral lesion. For bacterial infections, chlorhexidine gluconate 0.12% rinse can be used twice daily 1. In cases of fungal infections like thrush, nystatin suspension (100,000 units/mL) can be swished and swallowed 4 times daily for 7-14 days.
For inflammatory conditions such as aphthous ulcers, applying triamcinolone acetonide 0.1% dental paste 2-3 times daily can help reduce inflammation and promote healing. Systemic medications like acetaminophen or ibuprofen may be necessary for pain management in more severe cases. If a bacterial infection is suspected, antibiotics such as amoxicillin may be prescribed, but this should be based on a clear diagnosis and consideration of the potential for antimicrobial resistance, as highlighted in guidelines for treating infections like MRSA 1.
It's crucial to tailor the treatment to the child's age, weight, and specific diagnosis, ensuring proper dosing to avoid adverse effects. Given the potential for MRSA and other resistant infections, guidelines recommend considering the use of antibiotics like clindamycin, which is effective against CA-MRSA and can be used in children 1. However, the decision to use systemic antibiotics should be made cautiously and based on the severity of the infection and the presence of systemic symptoms or signs of severe disease.
In all cases, the goal is to reduce symptoms, promote healing, and prevent complications while minimizing the risk of adverse effects and the development of antibiotic resistance. Therefore, topical treatments and supportive care should be the first line of approach for oral lesions in children, reserving systemic antibiotics for cases where they are clearly indicated.
From the FDA Drug Label
Amoxicillin for oral suspension is a penicillin-class antibacterial indicated for treatment of infections due to susceptible strains of designated microorganisms The FDA drug label does not answer the question.
From the Research
Medication Options for Oral Lesions in Children
The following medication options are available for oral lesions in children:
- Topical anesthetic agents such as lidocaine and benzocaine 2, 3, 4, 5
- Combination of lidocaine and prilocaine, although not licensed for intraoral use 2
- Precaine (8% Lidocaine + 0.8% Dibucaine) and Precaine B (20% Benzocaine) 3
- EMLA 5% oral adhesive, although not recommended due to lack of demonstrated superiority in efficacy and subject preference 4
- Lidocaine patch (DentiPatch) 5
Considerations for Medication Choice
When choosing a medication for oral lesions in children, consider the following:
- Effectiveness of the medication in reducing pain and discomfort 2, 3, 4, 5
- Potential for toxicity, especially in children under 6 years old 6
- Ease of application and acceptance by the child 4, 5
- Potential for complications associated with systemic absorption 4
- Cost of the medication 4
Specific Medications and Their Effects
- Lidocaine is effective at concentrations between 5% and 20% 2
- Benzocaine is effective when used alone at a concentration of 20% and when combined at a dose of 15% with 1.7% amethocaine 2
- Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as effectively as Precaine B (20% Benzocaine) 3
- Lidocaine patch (DentiPatch) is associated with some objective evidence of reduced pain compared to benzocaine gel 5