What antibiotic should be prescribed for a patient with a tooth abscess?

Antibiotic Treatment for Tooth Abscess

For a tooth abscess, amoxicillin or phenoxymethylpenicillin should be prescribed only when antibiotics are indicated, as surgical drainage is the primary treatment. 1

Primary Management Approach

• Surgical intervention is the cornerstone of treatment for dental abscesses and should not be delayed 1
• Treatment options include:
  • Root canal therapy for salvageable teeth 1
  • Tooth extraction for non-restorable teeth 1
  • Incision and drainage for accessible abscesses 1

When to Use Antibiotics

Antibiotics should be prescribed only in specific situations:

• Presence of systemic symptoms (fever, malaise) 1
• Evidence of spreading infection or cellulitis 1
• Immunocompromised patients 1
• Incomplete or difficult surgical drainage 1

Antibiotic Selection Algorithm

First-line options (when antibiotics are indicated):

• Amoxicillin 500mg three times daily for 5 days OR Phenoxymethylpenicillin (Penicillin V) 1, 2
  • Amoxicillin is effective against the most common bacteria in dental infections, including oral streptococci 2, 3
  • Bacterial sensitivity to amoxicillin in dental abscesses is approximately 76.6% 3

For penicillin-allergic patients:

• Clindamycin 300-450mg four times daily 4, 1
  • Clindamycin has shown excellent efficacy against odontogenic infections 5
  • No bacterial resistance to clindamycin was found in a comparative study of odontogenic infections 5

For treatment failures or severe infections:

• Consider adding metronidazole to amoxicillin 1
• For severe infections with systemic involvement, consider parenteral antibiotics 4

Common Pitfalls to Avoid

• Prescribing antibiotics without surgical intervention: Multiple systematic reviews show no statistically significant differences in pain or swelling outcomes when antibiotics are used without addressing the source of infection 1
• Prolonged antibiotic course: A 5-day course is typically sufficient when surgical intervention has been performed 1
• Overlooking the need for follow-up: If symptoms persist despite appropriate treatment, reevaluation is necessary 1
• Ignoring microbial spectrum: Dental abscesses typically contain mixed aerobic and anaerobic bacteria, requiring appropriate antibiotic coverage when indicated 5, 3

Special Considerations

• Short-course, high-dose amoxicillin regimens have shown similar efficacy to conventional penicillin regimens 6
• For infections extending into cervicofacial tissues, more aggressive management is required 1
• Systematic reviews have shown that antibiotics alone provide no additional benefit when proper drainage has been achieved 7