Antibiotics

Background:

Antibiotics travel in the bloodstream. If bacteria are not present (irreversible pulpitis) or blood flow is compromised (necrotic pulp) antibiotics are not beneficial. This is because there are no bacteria to kill or the antibiotics can not travel inside the tooth to reach the source of the problem. Antibiotics should be prescribed in conjunction with dental treatment (root canal, extraction, I&D) when there are systemic signs of an infection, fever (>100 degrees), malaise, swelling, trismus, cellulitis, osteomyelitis, persistent infections. They are not indicated for healthy patients with localized swelling or in cases where a periapical radiolucency is present when there is an absence of systemic involvement.

They are also used as prophylaxis for patient’s with a prosthetic cardiac valve, congenital heart defect, history of endocarditis, cardiac transplant, and for immunocompromised patients (HIV/AIDS, chemotherapy, uncontrolled diabetes, patient’s taking immunosuppressant medications).

MILD-MODERATE INFECTIONS

1000 mg loading dose followed by 500 mg QID for 7 days

1000 mg loading dose followed by 500 mg TID for 7 days
This is the preferred 1st line antibiotic. Patient’s tend to be more compliant because the medication is taken three times a day vs four with penicillin.

1000 mg loading dose followed by 500 mg TID

This should only be used with penicillin if a patient’s symptoms do not improve in 48-72 hrs.

SEVERE INFECTIONS

875/125 mg BID for 7 days

600 mg loading dose followed by 300 mg TID for 7 days

*Has been associated with pseudomembranous colitis and has a black box warning for C. difficile. Use with caution.

PENICILLIN ALLERGY

500 mg loading dose, then 250 mg for 4 days

This is the preferred antibiotic for patients with a penicillin allergy.

600 mg loading dose followed by 300 mg TID for 7 days

The ADA and AHA no longer recommend using clindamycin because it has been associated with pseudomembranous colitis and has a black box warning for C. difficile. Use with caution.

PROPHYLAXIS

2 grams 1 hour prior to treatment

500 mg 1 hour prior to treatment

600 mg 1 hour prior to treatment

The ADA and AHA no longer recommend using clindamycin as a premedication because it has been associated with pseudomembranous colitis and has a black box warning for C. difficile. Use with caution.