Is Clindamycin (antibiotic) effective for treating a dental abscess?

From the Guidelines

Clindamycin is an effective antibiotic for treating dental abscesses, particularly for patients who are allergic to penicillin or when first-line antibiotics have failed, with a recommended adult dosage of 300mg taken orally every 6 hours (four times daily) for 5-7 days, as supported by the Infectious Diseases Society of America guidelines 1.

Key Points to Consider

• The typical adult dosage of clindamycin for dental abscesses is 300mg taken orally every 6 hours (four times daily) for 5-7 days.
• For severe infections, the dose may be increased to 450mg every 6 hours.
• Children's dosing is typically 8-25mg/kg/day divided into three or four doses.
• Clindamycin works by inhibiting bacterial protein synthesis, effectively stopping the growth and reproduction of bacteria causing the infection.
• Common side effects include diarrhea, nausea, and abdominal pain.
• If severe diarrhea occurs, contact your healthcare provider immediately as this could indicate a serious intestinal condition called Clostridioides difficile infection.
• While antibiotics help control the infection, dental abscesses typically require dental intervention such as drainage, root canal, or tooth extraction to fully resolve the problem.

Important Considerations

• The use of clindamycin for dental abscesses should be based on the severity of the infection and the patient's medical history, as recommended by the European Society of Cardiology guidelines 1.
• The guidelines from the Infectious Diseases Society of America 1 and the European Society of Cardiology 1 provide recommendations for the use of clindamycin in dental infections.
• It is essential to complete the entire course of antibiotic treatment, even if symptoms improve before finishing the medication, to ensure the infection is fully resolved.
• The patient should be monitored for signs of improvement or worsening of the infection, and the antibiotic treatment should be adjusted accordingly.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Anaerobes: Serious skin and soft tissue infections; Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin

Dental abscess is a type of skin and soft tissue infection.

• Clindamycin may be used to treat dental abscess if caused by susceptible anaerobic bacteria.
• Bacteriologic studies should be performed to confirm the causative organisms and their susceptibility to clindamycin. 2

From the Research

Clindamycin for Dental Abscess

• Clindamycin is an antibiotic that has been used to treat dental abscesses, particularly in patients who are allergic to penicillin 3, 4, 5, 6.
• However, studies have shown that clindamycin may not be the most effective antibiotic for treating dental abscesses, with higher rates of treatment failure and resistance compared to other antibiotics such as amoxicillin-clavulanic acid 3, 7.
• A systematic review of oral antibiotics for empirical management of acute dentoalveolar infections found that clindamycin was one of the antibiotics used, but the ideal choice and regimen were unclear 4.
• Another study found that clindamycin prophylaxis was not effective in preventing bacteremia following dental extractions, compared to amoxicillin and moxifloxacin 7.
• The role of clindamycin in the management of acute dentoalveolar abscesses has been reviewed, and it is recommended that antibiotic prescribing be kept to a minimum and based on evidence-based guidelines 6.

Effectiveness of Clindamycin

• A retrospective analysis found that clindamycin-treated patients had a higher rate of treatment failure (14.0% vs 2.2%) and required a longer duration of intravenous antibiotics compared to amoxicillin-clavulanic acid-treated patients 3.
• The same study found that significantly more isolated organisms in the clindamycin-treated group were resistant to clindamycin, which were all Streptococcus anginosus group 3.
• A study on the prevention of bacteremia following dental extractions found that clindamycin prophylaxis was not effective, with a prevalence of bacteremia of 85% at 30 seconds, 70% at 15 minutes, and 22% at 1 hour 7.

Recommendations

• The choice of antibiotic for treating dental abscesses should be based on evidence-based guidelines and take into account the patient's allergy history and the severity of the infection 3, 5, 6.
• Clindamycin may be considered as an alternative antibiotic for patients who are allergic to penicillin, but its effectiveness and potential for resistance should be carefully evaluated 3, 4, 7.
• Further research is needed to determine the ideal antibiotic regimen for treating dental abscesses and to develop evidence-based guidelines for antibiotic prescribing in dentistry 4, 6.