What antibiotic is recommended for treating gum swelling suspected to be of bacterial origin?

Antibiotic Treatment for Gum Swelling

For gum swelling suspected to be of bacterial origin, amoxicillin (500 mg three times daily for 7-10 days) is the recommended first-line antibiotic treatment. 1

First-Line Treatment Options

Oral Antibiotics

• Amoxicillin: 500 mg three times daily for 7-10 days 1, 2
  • Provides excellent coverage against common oral pathogens including streptococci and many anaerobes
  • FDA-approved with established efficacy against oral bacteria including Streptococcus species and other common oral pathogens 2

Alternative Options (for penicillin-allergic patients)

• Clindamycin: 300-450 mg four times daily for 7-10 days 1
  • Good activity against streptococci, staphylococci, and anaerobes
• Azithromycin: 500 mg once daily for 3 days 1
  • Convenient dosing schedule with good tissue penetration

Treatment Algorithm

1. Assess severity:

   • Mild localized gum swelling: Consider local measures first (oral hygiene, warm saline rinses)
   • Moderate to severe gum swelling with systemic symptoms: Start antibiotic therapy immediately

2. Select appropriate antibiotic:

   • No penicillin allergy: Amoxicillin 500 mg TID
   • Penicillin allergy: Clindamycin 300-450 mg QID or azithromycin 500 mg daily

3. Duration of therapy:

   • Standard course: 7-10 days 1
   • Reassess after 48-72 hours for clinical improvement 3

4. Adjunctive measures:

   • Maintain good oral hygiene
   • Use warm saline rinses (1/2 teaspoon salt in 8 oz warm water) 3-4 times daily
   • Apply topical antiseptic mouthwash (0.2% chlorhexidine) twice daily 1

Special Considerations

Severe Infections

For severe infections with significant swelling, fever, or systemic symptoms, consider:

• Amoxicillin-clavulanate: 875/125 mg twice daily 3
• Referral for possible surgical drainage if abscess is present 1

Complex Cases

For complex cases or treatment failures:

• Consider combination therapy with amoxicillin plus metronidazole (500 mg TID each) 1, 4
• This combination has shown superior results in treating severe periodontal infections 5

Important Caveats

• Antibiotics should supplement, not replace, appropriate dental care
• Dental evaluation is essential to identify and address the underlying cause
• Inadequate treatment may lead to spread of infection and serious complications including airway obstruction and septicemia 3
• Antibiotic resistance is a growing concern; use antibiotics judiciously and complete the full course of treatment 4

Follow-up

• Clinical reassessment within 48-72 hours of starting antibiotics
• If no improvement after 3 days, consider alternative antibiotics or referral for specialist evaluation
• Patients with ongoing signs of infection beyond 7 days warrant diagnostic re-evaluation 3