Dental Abscess Organism-Specific Therapy
- Author: Jane M Gould, MD, FAAP; Chief Editor: Thomas E Herchline, MD more...
Specific Organisms and Therapeutic Regimens
Most dental abscesses respond to surgical treatment (incision and drainage, root canal, or extraction) and elimination of the source of infection. The addition of antibiotics is not recommended for a localized dental abscess. Antibiotics are indicated if drainage is not possible or if the patient shows signs of systemic involvement or is immunocompromised. The duration of therapy should be 7 days.[1, 2, 3, 4, 5]
Organism-specific therapeutic regimens for dental abscess are provided below, including those for Fusobacterium, Bacteroides, Prevotella, Peptostreptococcus, Streptococcus, and Actinomyces.
Fusobacterium
- Penicillin VK 500mg PO TID or
- Penicillin G 2-4 million U IV/IM q4-6h
- Duration of therapy: 7d
If penicillin allergic:
- Clindamycin 300-450mg PO TID-QID or 600-900mg IV q6-8h
- Duration of therapy: 7d
Bacteroides
- Amoxicillin-clavulanate 500mg/125mg PO TID or
- Amoxicillin-clavulanate 875mg/125mg PO BID
- Duration of therapy: 7d
If penicillin allergic:
- Metronidazole 250-500mg PO TID or cefoxitin 1-2g IV q6h or cefotetan 2g IV q12h
- Duration of therapy: 7d
Prevotella
- Amoxicillin-clavulanate 500mg/125mg PO TID or
- Amoxicillin-clavulanate 875mg/125mg PO BID
- Duration of therapy: 7d
If penicillin allergic:
- Cefoxitin 1-2g IV q6h or metronidazole 250-500mg PO TID or clindamycin 300-450mg PO TID-QID or 600-900mg IV q6-8h
- Duration of therapy: 7d
Peptostreptococcus
- Amoxicillin 500mg PO TID or 1g PO BID or
- Penicillin VK 250-500mg PO TID-QID or
- Penicillin G 2-4 million U IV/IM q4-6h or
- Clindamycin 300-450mg PO TID-QID or 600-900mg IV q6-8h or
- Cefotetan 2g IV q12h
- Duration of therapy: 7d
Streptococcus species
- Amoxicillin 500mg PO BID or
- Penicillin V 250-500mg PO TID-QID or
- Penicillin G 2-4 million U IV/IM q4-6h or
- Clindamycin 300-450mg PO TID-QID or 600-900mg IV q6-8h or
- Cefoxitin 1-2g IV q6h or
- Cefotetan 2g IV q12h
- Duration of therapy: 7d
Actinomyces
- Penicillin G 2-4 million U IV/IM q4-6h[5] or
- Clindamycin 600mg IV q8h or
- Doxycycline 100mg PO BID
- Duration of therapy: 7d
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