Amoxicillin Dosage for Tooth Infections
For a tooth infection, amoxicillin should be prescribed at 500 mg three times daily (every 8 hours) for 7-10 days. 1
Recommended Dosing Regimen
- Amoxicillin 500 mg orally three times daily for 7-10 days is the standard treatment for dental/tooth infections 1
- For more severe infections, the dose can be increased to 875 mg twice daily 2
- Treatment should continue for at least 48-72 hours after the patient becomes asymptomatic 2
- For infections caused by Streptococcus pyogenes, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 2
Clinical Considerations
Severity-Based Dosing
- For mild to moderate infections: 500 mg every 8 hours or 875 mg every 12 hours 2
- For severe infections: 875 mg every 12 hours or 500 mg every 8 hours 2
- For patients with systemic involvement (fever, lymphadenopathy, cellulitis), antibiotics are more strongly indicated 1
Alternative Options
- For penicillin-allergic patients, consider clindamycin 300 mg three times daily 1
- Amoxicillin-clavulanate (875/125 mg twice daily) may be considered for more complex infections or when beta-lactamase producing organisms are suspected 1
Important Clinical Considerations
- Surgical intervention (drainage, extraction, or root canal therapy) is often necessary and should not be delayed 1
- According to the European Society of Endodontology, antibiotics alone without surgical intervention are insufficient for treating dental abscesses 1
- For acute dental abscesses, treatment is primarily surgical (root canal therapy or extraction) 1
- For acute dentoalveolar abscesses, incision and drainage followed by amoxicillin for 5 days is recommended 1
Dosage Adjustments
- For patients with severe renal impairment (GFR 10-30 mL/min): 500 mg or 250 mg every 12 hours 2
- For patients with very severe renal impairment (GFR <10 mL/min): 500 mg or 250 mg every 24 hours 2
- Patients with a GFR less than 30 mL/min should NOT receive the 875 mg dose 2
Administration Guidelines
- Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 2
- For oral suspension, shake well before using and refrigeration is preferable but not required 2
Evidence Quality and Considerations
Recent research suggests that shorter courses (3-5 days) may be as effective as longer courses for some dental infections, but evidence is limited 3. A study comparing amoxicillin with amoxicillin-clavulanate found the combination to be more effective in reducing pain and swelling after oral-surgical interventions 4, which may be relevant for more complex tooth infections.
Amoxicillin achieves adequate concentrations in dental tissues, with mean concentrations of 0.502 μg/g in roots and 0.171 μg/g in crowns after a single dose, which exceeds the minimal inhibition concentration for many oral bacteria 5.