What antibiotic is recommended for an elderly woman with a tooth abscess and no known antibiotic allergies?

Antibiotic for Tooth Abscess in an Elderly Woman

Amoxicillin-clavulanate (Augmentin) 875 mg/125 mg twice daily for 5 days is the recommended first-line antibiotic for an elderly woman with a tooth abscess, given her age >65 years places her at higher risk for resistant organisms. 1

Primary Treatment Principle

• Surgical intervention (drainage, extraction, or root canal debridement) must be the primary treatment, with antibiotics serving only as adjunctive therapy 1
• Antibiotics alone without surgical source control are insufficient for proper management of dental infections 1

First-Line Antibiotic Selection

For this elderly patient, amoxicillin-clavulanate is preferred over amoxicillin alone because:

• Age >65 years is a specific risk factor for infection with resistant organisms, particularly penicillin-resistant Streptococcus pneumoniae and beta-lactamase producing bacteria 2
• The clavulanate component provides coverage against beta-lactamase-producing organisms that may be present in odontogenic infections 1
• Amoxicillin-clavulanate 625-875 mg three times daily (or 875/125 mg twice daily) for 5-7 days is the recommended regimen 1

Dosing Regimen

• Amoxicillin-clavulanate 875 mg/125 mg orally twice daily for 5 days 1
• Alternative dosing: 625 mg three times daily for 5-7 days 1
• Five days is typically sufficient; avoid prolonged courses when not indicated 1

When Antibiotics Are Indicated

Antibiotics should be prescribed when the patient has:

• Systemic involvement (fever, lymphadenopathy) 1
• Diffuse or progressive swelling 1
• Infection extending into cervicofacial tissues 1
• Immunocompromising conditions (particularly relevant in elderly patients) 1

Alternative if Penicillin Allergy

If the patient had a penicillin allergy:

• Clindamycin 300-450 mg three times daily would be the preferred alternative 2, 1
• Azithromycin or other macrolides are less preferred due to high resistance rates (>40% for S. pneumoniae) 2

Monitoring and Follow-Up

• Reassess at 2-3 days for resolution of fever, marked reduction in swelling, and improved function 1
• If no improvement by 48-72 hours, consider inadequate source control, resistant organisms, or alternative diagnoses rather than simply extending antibiotics 1
• Failure to improve should prompt investigation for inadequate surgical drainage, not just antibiotic switching 1

Common Pitfalls to Avoid

• Never prescribe antibiotics without ensuring proper surgical intervention (extraction, drainage, or endodontic treatment) 1
• Avoid using amoxicillin alone in elderly patients—the age >65 years specifically warrants amoxicillin-clavulanate 2
• Do not prescribe prolonged courses (>7 days) when 5 days is typically sufficient 1
• Avoid prescribing antibiotics for conditions like irreversible pulpitis where surgical management alone is sufficient 1

Renal Dosing Consideration

• Elderly patients are more likely to have decreased renal function; amoxicillin-clavulanate is substantially excreted by the kidney 3
• For severe renal impairment (GFR <30 mL/min), dosage adjustment is required 3
• Consider monitoring renal function in elderly patients 3