What is the recommended dose of amoxicillin (amoxycillin) for post dental extraction?

Amoxicillin Dosing for Post-Dental Extraction

For routine post-dental extraction prophylaxis in healthy patients, amoxicillin 500 mg orally three times daily for 5-7 days is the standard recommended regimen. 1, 2

Standard Dosing Regimens

For Healthy Patients

• Amoxicillin 500 mg orally three times daily for 5-7 days is the primary recommendation for post-extraction antibiotic therapy when indicated 1, 2
• Treatment should continue until 2-3 days after resolution of symptoms 3

For Complex Infections or Beta-Lactamase Concerns

• Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days is preferred when beta-lactamase producing organisms are suspected or for more complex infections 1, 3, 2
• Alternative dosing: Amoxicillin-clavulanate 500/125 mg three times daily for 5-7 days 3
• Research supports that amoxicillin-clavulanate demonstrates significantly better outcomes than amoxicillin alone after oral surgical interventions, with less pain and swelling at 48 hours and 7 days post-operatively 4

For Penicillin-Allergic Patients

• Clindamycin 300-450 mg orally three times daily for 5-7 days 1, 3, 2
• Note: Research shows clindamycin is significantly less effective than amoxicillin in preventing post-extraction bacteremia, so use only when penicillin allergy is documented 5

Special Population: Post-Radiation Therapy Patients

For patients with prior head and neck radiation therapy (≥50 Gy to the jaw), a different approach is required to prevent osteoradionecrosis (ORN):

Antibiotic Protocol for High-Risk Patients

• Initiate antibiotics 1 hour to 1 day before the extraction procedure 6
• Continue for 5-7 days post-extraction 6
• The specific antibiotic used in high-quality studies was amoxicillin, administered 1 hour before the procedure and three times daily for 5 days postoperatively 6
• This perioperative antibiotic approach is recommended for patients at higher risk for ORN due to prior radiation therapy encompassing the mandible/maxilla at the extraction site 6

Additional Measures for Post-Radiation Patients

• Chlorhexidine gluconate 0.12% or 0.2% mouth rinse at least twice daily until adequate healing is achieved 6
• Consider pentoxifylline 400 mg twice daily plus tocopherol 1,000 IU once daily starting at least 1 week before and continuing 4 weeks after extraction for patients who received ≥50 Gy radiation dose 6

Critical Clinical Considerations

When Antibiotics Are Actually Indicated

Antibiotics alone are insufficient for treating dental infections—surgical intervention is essential and should never be delayed. 1, 3, 2

• For acute dental abscesses: Primary treatment is surgical (drainage, root canal, or extraction) WITHOUT routine antibiotics 1, 3, 2
• For acute dentoalveolar abscesses: Incision and drainage FIRST, then amoxicillin for 5 days 1, 3
• Antibiotics are adjunctive when systemic involvement is present: fever, lymphadenopathy, cellulitis, diffuse swelling, or in medically compromised patients 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics for conditions requiring only surgical management (e.g., localized abscesses without systemic signs) 1, 3
• Do not delay necessary surgical intervention while relying solely on antibiotics—this is a critical error that worsens outcomes 1, 3
• Do not use antibiotics for irreversible pulpitis, which does not benefit from antimicrobial therapy 1, 3
• Do not use prolonged courses when 5-7 days is sufficient for most post-extraction scenarios 3

Evidence Quality Considerations

Research demonstrates that oral amoxicillin (3 g single dose pre-procedure) reduces post-extraction bacteremia to 10% compared to 89% with no prophylaxis (p=0.05), while topical amoxicillin is significantly less effective at 60% 7. Multiple studies confirm amoxicillin's superiority over clindamycin and chlorhexidine for preventing post-extraction bacteremia 8, 5.

Practical Algorithm

1. Assess if antibiotics are needed: Only prescribe if systemic involvement, high-risk patient (immunocompromised, post-radiation), or surgical drainage performed
2. For healthy patients with indication: Amoxicillin 500 mg TID × 5-7 days 1, 2
3. For complex infections: Amoxicillin-clavulanate 875/125 mg BID × 5-7 days 1, 3
4. For penicillin allergy: Clindamycin 300-450 mg TID × 5-7 days 1, 3
5. For post-radiation patients (≥50 Gy): Start amoxicillin 1 hour before procedure, continue TID × 5 days, plus chlorhexidine rinses 6