What is the recommended dose of amoxicillin (amoxicillin) for dental prophylaxis (dental ppx)?

Amoxicillin Dose for Dental Prophylaxis

For adults requiring antibiotic prophylaxis before dental procedures, give amoxicillin 2 grams orally as a single dose 30-60 minutes before the procedure. 1

Standard Dosing Regimen

Adults:

• Amoxicillin 2 g orally, taken 30-60 minutes (or 1 hour) before the dental procedure 1, 2
• This is a single dose with no postoperative antibiotics needed 1

Children:

• Amoxicillin 50 mg/kg orally, taken 30-60 minutes before the procedure 1
• Maximum pediatric dose should not exceed the adult dose of 2 g 1

Who Requires Prophylaxis

Antibiotic prophylaxis should only be given to patients with the highest-risk cardiac conditions undergoing high-risk dental procedures 1, 2:

Highest-risk cardiac conditions include:

• Prosthetic cardiac valves or prosthetic material used for valve repair 1, 3
• Previous history of infective endocarditis 1, 3
• Unrepaired cyanotic congenital heart disease (CHD) 1, 4
• Completely repaired CHD with prosthetic material during the first 6 months after procedure 1, 4
• Repaired CHD with residual defects at or adjacent to prosthetic patch/device 1, 4
• Cardiac transplant recipients with cardiac valvulopathy 1, 3, 4

High-risk dental procedures requiring prophylaxis:

• Manipulation of gingival tissue (including scaling and root planing) 1, 2, 3
• Manipulation of periapical region of teeth (including root canal procedures) 1, 3, 4
• Perforation of oral mucosa 1, 3, 4

Alternative Regimens for Penicillin Allergy

If unable to take oral medication:

• Ampicillin 2 g IM or IV within 30 minutes before procedure 1, 2
• OR Cefazolin 1 g IM or IV 1
• OR Ceftriaxone 1 g IM or IV 1

If penicillin allergic (oral):

• Clindamycin 600 mg orally 1 hour before procedure 1, 2
• OR Azithromycin 500 mg orally 1
• OR Clarithromycin 500 mg orally 1
• OR Cephalexin 2 g orally (only if no history of anaphylaxis, angioedema, or urticaria with penicillin) 1

If penicillin allergic and unable to take oral medication:

• Clindamycin 600 mg IM or IV 1
• OR Cefazolin 1 g IM or IV (only if no history of anaphylaxis, angioedema, or urticaria with penicillin) 1
• OR Ceftriaxone 1 g IM or IV (only if no history of anaphylaxis, angioedema, or urticaria with penicillin) 1

Critical Pitfalls to Avoid

• Do not prescribe postoperative antibiotics - a single preoperative dose is sufficient 1, 2
• Do not use 3 g doses - while one older study examined 3 g, the 2 g dose provides adequate serum levels for 6+ hours and has fewer gastrointestinal side effects 5
• Do not prescribe prophylaxis for low-risk patients - patients with mitral valve prolapse, pacemakers, or other non-high-risk conditions do not require prophylaxis 2, 4
• Do not use cephalosporins in patients with history of anaphylaxis to penicillin - cross-reactivity risk exists 1
• Avoid Augmentin (amoxicillin-clavulanate) as first-line - plain amoxicillin is the recommended standard 4
• Do not prescribe prophylaxis for non-invasive procedures - routine anesthetic injections through non-infected tissue, dental radiographs, or placement of removable appliances do not require prophylaxis 1, 2

Special Considerations

For patients on anticoagulants:

• Prefer oral administration over intramuscular injections to avoid hematoma risk 2, 3

For patients already on antibiotics:

• Select an antibiotic from a different class rather than increasing the current antibiotic dose 2, 3

For patients on hemodialysis:

• The standard 2 g amoxicillin dose remains appropriate if not penicillin allergic 2

Evidence Quality Note

The evidence supporting antibiotic prophylaxis is based on expert consensus rather than randomized controlled trials 1, 6. The American Heart Association acknowledges that only an extremely small number of endocarditis cases might be prevented by prophylaxis, even if 100% effective 1, 4. However, given the high mortality rate of infective endocarditis (despite its low incidence), prophylaxis remains recommended for the highest-risk patients 1. Maintaining excellent oral hygiene and regular dental care is more important for preventing endocarditis than antibiotic prophylaxis 1, 2, 4.