| Drug | Dose | Use |
|---|---|---|
| Penicillin V | Loading: 1000 mg; Then: 500 mg q6h for 5 days | First choice for most odontogenic infections (gram-positive) |
| Metronidazole | Loading: 800 mg; Then: 400 mg q12h for 5 days | Second choice, especially if anaerobic bacteria are suspected |
| Clindamycin | Loading: 300 mg; Then: 150 mg q8h for 5 days | First choice if penicillin allergic; broad antibacterial spectrum |
| Amoxicillin | 2 gm 1 hour pre-op (prophylaxis) | Primarily for prophylaxis against infective endocarditis |
| Tetracycline | (Dose not specified for this use) | Prevention of root resorption after dental trauma (inflammatory and replacement) |
**Penicillin V
-
==Generic Name: Phenoxymethylpenicillin.==
-
First choice oral AB for most odontogenic infections (especially gram +ve organisms)
-
Narrow - but appropriate - spectrum
-
1000 mg loading dose
-
Then: 500 mg every 6 hrs, 1 hr before meals ⌂ 5 days
Patient Instructions
Must be taken on an empty stomach (1 hour before or 2 hours after meals) to ensure proper absorption. The typical course is 4-5 days.
Metronidazole[^36]
- Second choice oral antibiotic
- especially if anaerobic bacteria suspected
- Has synergistic reaction with penicillin
- 800 mg loading dose
- Then: 400 mg every 12 hrs for 5 days
Critical Warning
==Patients must be warned to avoid all alcohol while taking Metronidazole and for at least 48 hours after, due to the risk of a severe disulfiram-like reaction.==
Clindamycin[^37]
- First choice oral antibiotic - if patient is allergic to penicillin
- Very good spectrum of antibacterial action against oral organisms
- 300 mg loading dose
- Then: 150 mg every 8 hrs for 5 days
**Amoxicill
Speaker's Preference
==The speaker reserves Amoxicillin primarily for prophylaxis against infective endocarditis in at-risk patients, rather than for treating active infections.==
- For prophylaxis
- e.g. Against infective endocarditis
- Latest guidelines: 2 gm one hour pre-op.
- Use clindamycin 600 mg 1 hr pre-op if pt. has a history of allergy to the penicillins
- Follow published guidelines
- Constantly changing !!!
Tetracycline
- Research shows it is the AB of choice for the prevention of root resorption after dental trauma
- Inflammatory and replacement resorption
- (Sae-Lim, Wang, Trope EDT 1998; 14: 216-20)