What is the recommended dosage of amoxicillin (amoxicillin) for dental infections?

Amoxicillin Dosage for Dental Infections

For dental infections in adults, amoxicillin 500 mg orally three times daily for 5-7 days is the standard recommended treatment, but surgical intervention (drainage, extraction, or root canal) must be performed first, as antibiotics alone are insufficient. 1, 2

Standard Dosing Regimens

Adults and Pediatric Patients ≥40 kg

• Mild to moderate infections: 500 mg every 12 hours OR 250 mg every 8 hours 3
• Severe infections: 875 mg every 12 hours OR 500 mg every 8 hours 3
• Standard treatment duration: 5-7 days for most dental infections 1, 2
• Alternative duration: 7-10 days is also supported by guidelines 1, 4

Pediatric Patients (3 months to <40 kg)

• Mild to moderate infections: 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours 3
• Severe infections: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 3

Infants <3 months

• Maximum dose: 30 mg/kg/day divided every 12 hours (due to immature renal function) 3

When to Use Amoxicillin-Clavulanate Instead

For complex infections or suspected beta-lactamase producing organisms, use amoxicillin-clavulanate 875/125 mg twice daily. 1, 2, 4

• This combination is more effective than amoxicillin alone for odontogenic infections, with significantly reduced pain and swelling 5
• The 875/125 mg formulation provides superior pharmacokinetics, maintaining therapeutic levels above MIC for approximately 49% of the dosing interval 6

Critical Treatment Principles

Surgical Intervention is Mandatory

• Antibiotics alone without surgical drainage, extraction, or root canal therapy will fail regardless of antibiotic choice 2, 4
• For acute dentoalveolar abscesses: perform incision and drainage first, then prescribe amoxicillin for 5 days 1, 2
• For acute dental abscesses: treatment is primarily surgical; antibiotics serve only as adjunctive therapy 1, 2

Shortened Course Evidence

• Research demonstrates that 2-3 days of antibiotics may be sufficient when adequate drainage is established, with 98.6% of patients showing resolution 7
• However, current guidelines still recommend 5-7 days as the standard duration 1, 2

Special Populations

Renal Impairment

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 3
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3
• Hemodialysis: 500 mg or 250 mg every 24 hours, with additional dose during and after dialysis 3
• Patients on dialysis: Prolong dosing interval to every 24 hours 8

Penicillin-Allergic Patients

• Clindamycin 300 mg three times daily is the recommended alternative 1, 2

When Antibiotics Are Actually Indicated

Antibiotics should be added to surgical treatment when:

• Systemic involvement: fever, lymphadenopathy, or cellulitis 2
• Diffuse swelling extending beyond the immediate area 2
• Medically compromised patients 2
• Progressive infections despite initial surgical management 2

Common Pitfalls to Avoid

• Never prescribe antibiotics without addressing the infection source through drainage or extraction 4
• Do not substitute two 250 mg tablets for one 500 mg tablet when using amoxicillin-clavulanate, as this results in excessive clavulanate dosing and increased gastrointestinal side effects 4
• Avoid prescribing antibiotics for irreversible pulpitis, which does not benefit from antimicrobial therapy 2
• Do not delay necessary surgical intervention while relying solely on antibiotics 2
• Take amoxicillin at the start of a meal to minimize gastrointestinal intolerance 3

Administration Details

• Continue treatment for minimum 48-72 hours beyond symptom resolution 3
• For Streptococcus pyogenes infections, treat for at least 10 days to prevent acute rheumatic fever 3
• Oral suspension must be shaken well before each use and discarded after 14 days 3