What is the recommended dose of amoxicillin (amoxicillin) for a jaw infection?

Amoxicillin Dosing for Jaw Infections

For jaw infections in adults, amoxicillin 500 mg orally three times daily for 7-10 days is the recommended standard treatment, though amoxicillin-clavulanate 875/125 mg twice daily is preferred when beta-lactamase producing organisms or more complex odontogenic infections are suspected. 1

Primary Treatment Recommendations

Standard Amoxicillin Dosing

• Amoxicillin 500 mg orally three times daily (every 8 hours) for 7-10 days is the standard regimen recommended by the American College of Physicians and the Infectious Diseases Society of America for dental/tooth infections 1
• The FDA-approved dosing for ear/nose/throat and skin/skin structure infections of mild to moderate severity is 500 mg every 12 hours or 250 mg every 8 hours, while severe infections require 875 mg every 12 hours or 500 mg every 8 hours 2

When to Use Amoxicillin-Clavulanate Instead

• Amoxicillin-clavulanate 875/125 mg twice daily is specifically recommended for more complex dental infections or when beta-lactamase producing organisms are suspected 1
• The Infectious Diseases Society of America recommends amoxicillin-clavulanate (875/125 mg bid) for animal or human bites involving the jaw/face, as these infections involve mixed aerobic and anaerobic bacteria 3
• Amoxicillin-clavulanate provides broader coverage against oral flora that may produce beta-lactamases, making it more appropriate for severe odontogenic infections 4

Critical Clinical Considerations

Surgical Intervention is Essential

• Antibiotics alone are insufficient for treating dental abscesses - the European Society of Endodontology emphasizes that surgical intervention (drainage, extraction, or root canal therapy) is necessary and should not be delayed 1
• For acute dentoalveolar abscesses, the European Society of Clinical Microbiology and Infectious Diseases recommends incision and drainage followed by amoxicillin for 5 days 1
• Treatment should be primarily surgical (root canal therapy or extraction) for acute dental abscesses, with antibiotics serving as adjunctive therapy 1

Duration of Therapy

• Treatment duration of 7-10 days is standard for most dental infections 1
• One randomized controlled trial found that a 3-day course of amoxicillin was non-inferior to 7 days for odontogenic infections requiring tooth extraction, though this study had participants starting antibiotics 2 days before extraction (not typical practice) 5
• Continue treatment for a minimum of 48-72 hours beyond symptom resolution or evidence of bacterial eradication 2

Administration Guidelines

• Take amoxicillin at the start of a meal to minimize gastrointestinal intolerance 2
• Shake oral suspension well before using; refrigeration is preferable but not required 2

Alternative Regimens for Special Situations

Penicillin Allergy

• For penicillin-allergic patients, the European Society of Clinical Microbiology and Infectious Diseases suggests clindamycin 300 mg three times daily 1

Renal Impairment

• Patients with GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 2
• Patients with GFR <10 mL/min: 500 mg or 250 mg every 24 hours 2
• Patients with GFR <30 mL/min should NOT receive the 875 mg dose 2

Common Pitfalls to Avoid

• Do not prescribe antibiotics without addressing the source - failure to perform necessary drainage or extraction will result in treatment failure regardless of antibiotic choice 1
• Do not substitute two 250 mg tablets for one 500 mg tablet when using amoxicillin-clavulanate, as this results in excessive clavulanate dosing 6
• Avoid using amoxicillin-clavulanate 500/125 mg three times daily when the 875/125 mg twice daily formulation is more appropriate, as the latter provides better compliance and similar efficacy 7