Amoxicillin Dosing for Gum Infections
For uncomplicated periodontal (gum) infections in adults, amoxicillin 500 mg three times daily for 7-10 days is the standard regimen, though mechanical debridement remains the primary treatment and antibiotics should only be used as adjunctive therapy in specific situations.
When Antibiotics Are Actually Indicated
Systemic antibiotics are not routinely indicated for most periodontal infections and should only be used in specific circumstances 1:
- Aggressive periodontitis with rapid tissue destruction 1
- Acute periodontal abscess requiring drainage 2
- Necrotizing ulcerative gingivitis with systemic symptoms 2
- Poor response to mechanical debridement alone after adequate treatment 1
- Patients with systemic conditions affecting host resistance 1
Critical caveat: Mechanical debridement (scaling, root planing, curettage) is the cornerstone of treatment and antibiotics should never replace proper mechanical therapy 2, 1.
Adult Dosing Regimens
First-Line Treatment
- Amoxicillin 500 mg orally three times daily for 7-10 days 3
- Alternative: Penicillin V 500 mg orally four times daily 4, 3
Second-Line Treatment (if no improvement in 2-3 days)
- Amoxicillin-clavulanate (Augmentin) 875 mg twice daily for 7-10 days 2
- Alternative: Metronidazole 500 mg three times daily combined with amoxicillin 2
Penicillin Allergy
- Non-anaphylactic allergy: Erythromycin 500 mg four times daily 4, 3
- Severe allergy: Clindamycin 300 mg three times daily (reserve for refractory infections due to GI toxicity risk) 4, 3
- Alternative: Metronidazole 500 mg three times daily (note: less effective against gram-positive cocci, should not be used alone) 3
Pediatric Dosing
Standard Dosing
- Amoxicillin 45 mg/kg/day divided every 12 hours for mild-moderate infections 5
- Maximum daily dose: 4000 mg/day regardless of weight 5
For β-lactamase Producing Organisms
- Amoxicillin-clavulanate 45 mg/kg/day (of amoxicillin component) divided every 12 hours 5
- For severe infections: 90 mg/kg/day divided every 12 hours 5
Penicillin Allergy in Children
- Non-anaphylactic: Second or third-generation cephalosporins (cefdinir, cefuroxime) 5
- Serious allergy: Clindamycin 10-20 mg/kg/day divided into 3 doses 5
Renal Impairment Adjustments
While the provided evidence does not contain specific renal dosing for periodontal infections, standard practice requires dose reduction in significant renal impairment. For CrCl <30 mL/min, extend dosing intervals to every 12 hours for standard doses, or reduce individual doses by 50%.
Pregnancy Considerations
Amoxicillin is FDA Pregnancy Category B and is generally considered safe during pregnancy. It remains the preferred antibiotic for dental infections in pregnant patients. Metronidazole should be avoided in the first trimester. Tetracyclines are absolutely contraindicated throughout pregnancy 4.
Treatment Monitoring
- Expect clinical improvement within 48-72 hours 5
- If no improvement by 2-3 days, switch to second-line therapy 2
- Complete the full course even if symptoms resolve early 5
- Reassess need for surgical drainage if fever persists beyond 48 hours 2
Common Pitfalls to Avoid
Using antibiotics without mechanical debridement - This is the most common error; antibiotics alone will not resolve periodontal infections 2, 1
Prescribing amoxicillin-clavulanate as first-line - Reserve this for treatment failures or β-lactamase producing organisms 2
Using tetracyclines routinely - High GI side effects and superinfection risk limit their use 4, 3
Prescribing metronidazole alone - Inadequate coverage of gram-positive cocci; must be combined with penicillin or amoxicillin 3
Overusing clindamycin - Reserve for refractory infections due to risk of antibiotic-associated colitis 4, 3