What is the recommended dose of amoxicillin (amoxicillin) for post wisdom teeth extraction?

Amoxicillin Dosing for Post-Wisdom Teeth Extraction

For post-operative antibiotic therapy after wisdom teeth extraction, prescribe amoxicillin 500 mg orally three times daily for 5-7 days. 1, 2

Key Dosing Recommendations

Standard post-operative regimen:

• Amoxicillin 500 mg orally three times daily for 5-7 days is the most commonly recommended post-extraction protocol 1, 2, 3
• This regimen is supported by clinical practice patterns and guideline recommendations for dental infections requiring surgical intervention 1, 2

Alternative considerations:

• For more complex infections or when beta-lactamase producing organisms are suspected, amoxicillin-clavulanate 875/125 mg twice daily may be preferred 1, 2
• Research suggests amoxicillin-clavulanate combination demonstrates superior pain and swelling reduction compared to amoxicillin alone after oral surgical interventions 4

Evidence for Post-Operative Antibiotics

Efficacy in third molar extraction:

• Prophylactic antibiotics reduce infection risk by approximately 70% following impacted wisdom tooth extraction (number needed to treat = 12) 5
• Antibiotics reduce dry socket risk by 38% (number needed to treat = 38) 5
• Patients receiving antibiotics experience less pain 7 days post-extraction 5

Important caveat: The evidence base primarily comes from studies of prophylactic antibiotics (given before or immediately after surgery), not purely post-operative courses started days after extraction 5

When Antibiotics Are Indicated Post-Operatively

Prescribe post-operative antibiotics when:

• Systemic complications develop (fever, lymphadenopathy, cellulitis) 2
• Diffuse swelling is present 2
• Patient is medically compromised or immunodeficient 2, 5
• Progressive infection develops despite initial surgical management 2

Surgical intervention remains primary treatment:

• Antibiotics alone without surgical drainage or extraction are insufficient for treating dental abscesses 1, 2
• Do not delay necessary surgical intervention while relying solely on antibiotics 2

Penicillin-Allergic Patients

For true penicillin allergy:

• Clindamycin 300-400 mg orally three times daily is the recommended alternative 1, 2
• Avoid cephalosporins in patients with history of anaphylaxis, angioedema, or urticaria to penicillins 6

Common Pitfalls to Avoid

Do not prescribe antibiotics for:

• Routine, uncomplicated extractions in healthy patients without signs of infection 2
• Irreversible pulpitis, which does not benefit from antimicrobial therapy 2
• Situations where only surgical management is needed 2

Antibiotic stewardship concerns:

• Antibiotics cause mild transient adverse effects in 1 of every 21 patients treated 5
• The increasing prevalence of antibiotic-resistant bacteria requires careful consideration of whether treating healthy patients is appropriate 5
• Current prescribing practices show wide variation and often lack alignment with evidence-based guidelines 7, 3

Duration of Therapy

Optimal treatment length:

• While 5-7 days is standard practice 1, 2, 3, limited evidence suggests 3-day courses may be non-inferior to 7-day courses for odontogenic infections requiring extraction 8
• However, the single RCT supporting shorter duration had methodological limitations (antibiotics started 2 days pre-extraction, which is not standard practice) 8
• In clinical practice, prescribe 5-7 days to ensure adequate treatment while avoiding unnecessarily prolonged courses 1, 2