From the Guidelines
Treatment of oral infections typically involves a combination of antibiotics, pain management, and supportive care, with amoxicillin-clavulanate 875/125 mg bid being a recommended therapy for bacterial infections, as suggested by the Infectious Diseases Society of America 1.
Key Considerations
- For bacterial infections like dental abscesses, amoxicillin-clavulanate is often the first-line treatment, with alternatives such as ampicillin-sulbactam or carbapenems for patients with specific allergies or resistance patterns 1.
- Metronidazole may be added for anaerobic infections, and clindamycin is an alternative for penicillin-allergic patients 1.
- Pain can be managed with ibuprofen or acetaminophen, and dental intervention is crucial for definitive treatment of abscesses, including drainage, root canal, or extraction.
- For fungal infections like oral thrush, nystatin oral suspension or fluconazole is effective, as recommended by the Infectious Diseases Society of America 1.
Treatment Options
- Amoxicillin-clavulanate 875/125 mg bid for 7-10 days for bacterial infections
- Clindamycin 300 mg tid for penicillin-allergic patients
- Metronidazole 250-500 mg tid for anaerobic infections
- Nystatin oral suspension (100,000 units/mL) 4-6mL four times daily for 7-14 days or fluconazole 200mg on day one followed by 100mg daily for 7-14 days for fungal infections
- Acyclovir 400mg five times daily for 5 days for viral infections like herpes simplex
Supportive Care
- Maintaining good oral hygiene by brushing twice daily, flossing, and using antiseptic mouthwash
- Adequate hydration and soft, non-irritating foods during recovery
- Prompt treatment is essential as oral infections can spread to adjacent tissues and potentially cause serious complications if left untreated.
From the FDA Drug Label
1 INDICATIONS AND USAGE
Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae.
The treatment of oral infections with amoxicillin (PO) is indicated for infections due to susceptible (ONLY β-lactamase–negative) isolates of:
- Streptococcusspecies (α-and β-hemolytic isolates only)
- Streptococcus pneumoniae
- Staphylococcusspp.
- Haemophilus influenzae 2
From the Research
Treatment of Oral Infections
- Oral infections can be caused by various factors, including odontogenic sources, tonsil and lymphatic sources, oral trauma, radiation injury, chemotherapy mucositis, salivary gland infection, lymph node abscess, and postoperative infection 3.
- The treatment of oral infections often requires the use of antibiotics, in addition to the removal of the source of infection 4.
- The choice of antibiotic depends on the type of infection, the severity of the infection, and the patient's overall health 4.
Antibiotic Therapy
- Broad-spectrum antimicrobials can be used to treat serious bacterial infections, but it is essential to initiate therapy before the causative pathogen is identified 5.
- The primary role of antimicrobials is to limit the local and systemic spread of infection, and surgical drainage is of primary importance 6.
- The most effective antimicrobials against anaerobic organisms include metronidazole, carbapenems, chloramphenicol, and combinations of a penicillin and a beta-lactamase inhibitor 6.
Duration of Antibiotic Therapy
- The duration of antibiotic therapy should be as short as possible to minimize the risk of resistance and side effects 7, 4.
- A study found that a multifaceted intervention to optimize antibiotic prescribing at hospital discharge was associated with less frequent use of antibiotics with broad gram-negative activity and shorter postdischarge treatment durations 7.
- Another study found that antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved, and that all antibiotics tested are equally effective with respect to clinical cure, once drainage has been performed and/or the cause of infection has been removed 4.
Best Choice of Antibiotic
- The best choice of antibiotic for odontogenic infections is still a matter of debate, but a systematic review found that 15 different antibiotics were used in 2,197 cases, with a 98.2% overall cure rate 4.
- The review also found that antibiotics were prescribed only in situations of regional and/or systemic body manifestations, and that the choice of antibiotics is not as successful as the local intervention treatment procedure 4.