What antibiotic is recommended for a gum infection?

Antibiotic Treatment for Gum Infection

Amoxicillin is the first-line antibiotic for gum infections, with clindamycin as the preferred alternative for penicillin-allergic patients. 1

Treatment Algorithm Based on Clinical Presentation

Acute Dental/Dentoalveolar Abscess

• Surgical drainage is the primary treatment—antibiotics serve only as adjunctive therapy 2, 1
• For acute dentoalveolar abscesses requiring antibiotics: amoxicillin 500 mg three times daily for 5 days after incision and drainage 2
• Do not prescribe antibiotics for acute apical periodontitis or acute apical abscesses without systemic involvement—surgical drainage alone is sufficient 2

Moderate to Severe Infections or Extension to Surrounding Tissues

• Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily is recommended when infection extends into cervicofacial tissues or for more severe presentations 1, 3
• This combination provides enhanced coverage against beta-lactamase producing organisms 4

Chronic Periodontitis Requiring Antibiotic Therapy

• Antibiotics must be used as adjunct to mechanical debridement (scaling and root planing), never as standalone therapy 1, 5
• Metronidazole plus amoxicillin (250-375 mg of each three times daily for 8 days) is the most potent combination for chronic periodontitis with documented clinical attachment level gain and pocket depth reduction 2, 6
• Alternative: Sub-antimicrobial dose doxycycline 20 mg twice daily for 3-9 months as adjunct to scaling and root planing for chronic cases 2, 1

Penicillin-Allergic Patients

• Clindamycin 300-450 mg orally three times daily provides excellent coverage for staphylococci, streptococci, and anaerobes 1, 3
• Clindamycin is superior to macrolides (erythromycin, azithromycin) for dental infections in penicillin-allergic patients 3, 7

Specific Indications for Antibiotic Use

Antibiotics are indicated only when:

• Systemic involvement is present (fever, lymphadenopathy, malaise) 1
• Diffuse swelling extending beyond the dentoalveolar region 1
• Medically compromised patients with impaired host defenses 2, 5
• Progressive infection despite surgical drainage 2
• Aggressive periodontitis with documented periodontal pathogens 3, 5

Common Pitfalls to Avoid

• Never prescribe antibiotics without mechanical debridement of the periodontal pocket or surgical drainage of abscesses—this is the most common error in dental antibiotic prescribing 1, 5
• Avoid antibiotics for chronic periodontitis without clear evidence of active infection—mechanical therapy alone is adequate in most cases 1, 5
• Do not use broad-spectrum antibiotics empirically when narrower spectrum agents like amoxicillin are appropriate 2, 1
• Insufficient treatment duration—ensure 5-8 day courses for acute infections, not 3-day courses 2, 6

Special Considerations for Aggressive Periodontitis

• When Aggregatibacter actinomycetemcomitans is suspected or confirmed: doxycycline 100 mg twice daily or metronidazole plus amoxicillin combination 3, 8
• Sequential antibiotic therapy (doxycycline followed by amoxicillin-clavulanate) may offer superior results in recurrent/progressive periodontitis compared to single-agent therapy 8

Necrotizing Ulcerative Gingivitis

• Metronidazole is the preferred agent for fusiform bacilli and spirochetes 3
• Alternative: Amoxicillin-clavulanate 3