Amoxicillin-Clavulanate 875/125 mg for Tooth Infection
For dental infections, amoxicillin-clavulanate 875/125 mg should be dosed twice daily for 5-7 days, with surgical drainage being the primary treatment and antibiotics serving only as adjunctive therapy in specific circumstances. 1, 2, 3
Standard Dosing Regimen
The FDA-approved dosing is 875 mg/125 mg every 12 hours (twice daily) for more severe infections including respiratory tract infections and complicated dental infections. 2
The typical treatment duration for odontogenic infections is 5-7 days, which has been validated in clinical trials showing 88-89% clinical success rates. 3
This twice-daily regimen is preferred over three-times-daily dosing because it reduces gastrointestinal side effects (particularly diarrhea) while maintaining adequate antimicrobial coverage, as clavulanate causes dose-dependent GI toxicity when exceeding 10 mg/kg per day. 4
When Antibiotics Are Actually Indicated
Surgical drainage (incision and drainage, root canal therapy, or extraction) is the primary treatment for dental infections—antibiotics alone are insufficient. 1
The European Society of Endodontology explicitly states not to use antibiotics for acute apical periodontitis or acute apical abscesses when surgical drainage is feasible. 1
Antibiotics are indicated only as adjunctive therapy in these specific situations: 1
- Systemic involvement (fever, lymphadenopathy, malaise)
- Diffuse cellulitis or infections extending into cervicofacial tissues
- Medically compromised or immunocompromised patients
- Progressive infections despite adequate surgical drainage
For acute dentoalveolar abscesses, the recommended approach is incision and drainage followed by amoxicillin (or amoxicillin-clavulanate) for 5 days. 1
Clinical Effectiveness Data
A randomized trial of 472 patients with odontogenic infections demonstrated that amoxicillin-clavulanate 875/125 mg twice daily achieved 88.2% clinical success (defined as resolution of pain, swelling, fever without need for additional antimicrobials), which was non-inferior to clindamycin. 3
Clinical improvement typically occurs within 48-72 hours of initiating therapy when combined with appropriate surgical intervention. 5
Patients receiving amoxicillin-clavulanate showed significantly less pain at both 48 hours and 7 days post-operatively compared to amoxicillin alone in oral surgical interventions. 5
Administration and Tolerability
Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance. 2
The 875/125 mg formulation cannot be substituted with two 250/125 mg tablets, as this would result in excessive clavulanate dosing (250 mg vs. 125 mg). 2
Common adverse effects include diarrhea, raised liver enzymes, and headache, which are typically mild to moderate in intensity. 3
Critical Pitfalls to Avoid
Never prescribe antibiotics without addressing the source of infection surgically—this is the most common error in managing dental infections and leads to treatment failure. 1
Do not extend treatment beyond 7 days for uncomplicated dental infections, as longer courses increase adverse effects without improving outcomes. 3
Avoid using amoxicillin-clavulanate for chronic periodontitis or irreversible pulpitis, as antibiotics provide no benefit in these conditions. 1
In patients with severe renal impairment (GFR <30 mL/min), do not use the 875/125 mg formulation; use 500/125 mg or 250/125 mg with adjusted frequency instead. 2