What are the first-line antibiotics for a dental (tooth) infection?

From the Guidelines

For a tooth infection, the first-line antibiotic treatment is amoxicillin 2 g orally, as recommended by the American Heart Association 1. This is based on the guidelines for the prevention of infective endocarditis, which suggest amoxicillin as the preferred choice for oral therapy due to its high absorption in the GI tract and sustained serum concentrations. The dosage for adults is 2 g, and for children, it is 50 mg/kg. In cases where the patient is unable to take oral medication, ampicillin 2 g IM or IV, or cefazolin or ceftriaxone 1 g IM or IV, are recommended alternatives 1. For patients allergic to penicillins or ampicillin, cephalexin 2 g, clindamycin 600 mg, or azithromycin or clarithromycin 500 mg, are suggested as oral options 1. It is essential to note that while antibiotics are crucial in managing tooth infections, they do not replace the need for dental procedures such as root canal therapy, drainage, or tooth extraction to address the underlying cause of the infection. Some key points to consider include:

• The importance of completing the full course of antibiotics even if symptoms improve before finishing the medication.
• The potential for antibiotic resistance, particularly with the use of broad-spectrum antibiotics.
• The need for prompt dental care to prevent further complications.
• The use of pain relievers like ibuprofen or acetaminophen to manage discomfort alongside antibiotic therapy. Given the potential for resistance and the importance of effective treatment, amoxicillin remains the first-line choice for tooth infections, with alternatives available for patients with allergies or intolerance 1.

From the FDA Drug Label

Amoxicillin has been shown to be active against most isolates of the following microorganisms, both in vitroand in clinical infections [see Indications and Usage (1)] Gram-Positive Bacteria Enterococcus faecalis Staphylococcusspp. Streptococcus pneumoniae Streptococcusspp (alpha and beta-hemolytic) Gram-Negative Bacteria Escherichia coli Haemophilus influenzae Helicobacter pylori Proteus mirabilis

The first line antibiotics for a tooth infection may include Amoxicillin 2.

• Indications: Amoxicillin is active against a variety of bacteria, including Gram-Positive and Gram-Negative bacteria.
• Key points: The choice of antibiotic should be based on the suspected causative organisms and their susceptibility to the antibiotic. It is essential to note that Clindamycin 3 is also an option for treating serious infections caused by susceptible anaerobic bacteria, but its use should be reserved for penicillin-allergic patients or other patients for whom a penicillin is inappropriate.

From the Research

First Line Antibiotics for Tooth Infection

• The most commonly used antibiotics for tooth infections include penicillin, amoxycillin, erythromycin, clindamycin, and metronidazole 4.
• A study found that 96% of bacterial strains isolated from acute dentoalveolar abscesses were sensitive or moderately sensitive to these antibiotics 4.
• However, resistance was recorded for each of the antibiotics tested on at least one occasion, highlighting the need for careful selection of antibiotics 4.

Alternative Antibiotics

• Other antibiotics that have been used to manage dentoalveolar infections include amoxicillin/clavulanic acid, cefalexin, moxifloxacin, ornidazole, and phenoxymethylpenicillin 5.
• A systematic review found that the ideal choice, regimen, and spectrum of empirical oral antibiotics for acute dentoalveolar infections are unclear 5.
• The review suggested that narrow-spectrum agents may be as effective as broad-spectrum antibiotics in otherwise healthy individuals 5.

Antibiotic Resistance and Prescribing Guidelines

• There is a need for evidence-based prescribing guidelines to minimize antibiotic resistance and ensure appropriate treatment of tooth infections 6, 7.
• A review of the literature recommended suitable antibiotic prescribing for adult patients suffering from acute dentoalveolar infections based on evidence 7.
• The role of antibiotics in primary space odontogenic infections is questioned if drainage can be established, highlighting the importance of proper diagnosis and treatment 5, 8.