Is 625mg of amoxicillin (amoxicillin) twice a day for 5 days the correct dose for post-teeth extraction?

Amoxicillin 625mg Twice Daily for 5 Days Post-Extraction: Incorrect Dosing

The prescribed regimen of amoxicillin 625mg twice daily for 5 days is incorrect for routine post-extraction prophylaxis. Standard dosing for dental infections requires amoxicillin 500mg three times daily, and importantly, antibiotics are generally not indicated for routine uncomplicated tooth extractions in healthy patients.

Key Issues with the Prescribed Regimen

Dosing Frequency Problem

• The twice-daily dosing of plain amoxicillin is suboptimal - standard amoxicillin requires three times daily administration (500mg TID) to maintain adequate tissue concentrations for dental infections 1
• Amoxicillin-clavulanate formulations can be dosed twice daily (875/125mg BID), but plain amoxicillin 625mg is not a standard formulation and the twice-daily frequency is inadequate 1, 2

Duration Appropriateness

• The 5-day duration is acceptable when antibiotics are truly indicated, as evidence supports 5-day courses being as effective as 7-10 day courses for dental infections 2, 3, 4
• However, this assumes the correct antibiotic and dosing frequency are used 4

When Antibiotics Are Actually Indicated Post-Extraction

Routine Extractions in Healthy Patients

• Prophylactic antibiotics are NOT recommended for routine tooth extractions in healthy individuals 5
• The evidence shows you would need to treat 12 healthy patients to prevent one infection, raising concerns about antibiotic resistance versus benefit 5

Impacted Third Molar Extractions

• Antibiotics reduce infection risk by 70% (RR 0.29) and dry socket risk by 38% (RR 0.62) specifically for impacted wisdom tooth extractions 5
• If antibiotics are indicated for third molar surgery, use amoxicillin 500mg three times daily for 5-7 days 1, 5

High-Risk Patients Requiring Antibiotics

• Patients with immunocompromise, systemic illness, or signs of spreading infection (fever, lymphadenopathy, cellulitis) may benefit from antibiotic therapy 2
• For established infections post-extraction, use amoxicillin-clavulanate 875/125mg twice daily for 5 days as first-line therapy 2, 3

Correct Antibiotic Regimens When Indicated

Standard Amoxicillin

• Amoxicillin 500mg orally three times daily for 5-7 days is the evidence-based regimen for dental infections 1, 5
• This maintains adequate tissue concentrations throughout the dosing interval 6

Amoxicillin-Clavulanate (Preferred for Established Infections)

• Amoxicillin-clavulanate 875/125mg twice daily for 5 days provides superior coverage against beta-lactamase producing organisms 2, 7, 3
• Studies demonstrate this twice-daily formulation achieves equivalent or superior tissue penetration compared to 625mg three times daily 6
• Clinical success rates of 88-89% for odontogenic infections with 5-day courses 3

Penicillin-Allergic Patients

• Clindamycin 300-400mg three times daily for 5-7 days is the recommended alternative 1, 2
• Comparable efficacy to amoxicillin-clavulanate (89.7% vs 88.2% clinical success) 3

Critical Clinical Pitfalls to Avoid

Prescribing Antibiotics Without Surgical Intervention

• Antibiotics alone are insufficient for treating dental abscesses - surgical drainage, extraction, or root canal therapy is mandatory 1, 2
• Delaying definitive surgical treatment while relying on antibiotics leads to treatment failure 2

Using Non-Standard Formulations

• Amoxicillin 625mg is not a standard formulation in most countries 1
• The combination product amoxicillin-clavulanate comes as 500/125mg or 875/125mg, not plain amoxicillin 625mg 7, 6, 3

Inappropriate Prophylaxis for Endocarditis

• Modern AHA guidelines (2007) recommend single-dose prophylaxis (amoxicillin 2g orally 1 hour before procedure) only for high-risk cardiac conditions, not post-procedure courses 8
• Multi-day post-extraction antibiotic courses are not indicated for endocarditis prophylaxis 8

Recommended Action

For this patient, clarify the indication for antibiotics:

• If this is routine prophylaxis post-extraction in a healthy patient: discontinue antibiotics - they are not indicated 5
• If treating an established infection: switch to amoxicillin-clavulanate 875/125mg twice daily for 5 days 2, 3
• If using plain amoxicillin: correct to 500mg three times daily for 5-7 days 1, 5
• Ensure adequate surgical intervention (drainage/extraction) has been performed 1, 2