Dental Abscess Organism-Specific Therapy 

  • Author: Jane M Gould, MD, FAAP; Chief Editor: Thomas E Herchline, MD   more...
 
Updated: Sep 29, 2011
 

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
 
Contributor Information and Disclosures
Author

Jane M Gould, MD, FAAP  Assistant Professor of Pediatrics, Drexel University College of Medicine; Hospital Epidemiologist, Attending Physician, Section of Infectious Diseases, St Christopher's Hospital for Children

Jane M Gould, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, and Society for Healthcare Epidemiology of America

Disclosure: AstraZeneca Salary Employment; Prometheus Consulting fee Consulting

Coauthor(s)

Jeffrey J Cies, PharmD, BCPS  Pharmacy Clinical Coordinator, Critical Care Clinical Pharmacist, St Christopher's Hospital for Children

Jeffrey J Cies, PharmD, BCPS is a member of the following medical societies: American College of Clinical Pharmacy and American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Specialty Editor Board

Jasmeet Anand, PharmD, RPh  Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Thomas E Herchline, MD  Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

References
  1. Krebs KA, Clem DS 3rd. Guidelines for the management of patients with periodontal diseases. J Periodontol. Sep 2006;77(9):1607-11. [Medline].

  2. Stefanopoulos PK, Kolokotronis AE. The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 2004;98(4):398-408. [Medline].

  3. Brook I. Microbiology and management of endodontic infections in children. J Clin Pediatr Dent. 2003;28(1):13-7.

  4. Robertson D, Smith AJ. The microbiology of the acute dental abscess. J Med Microbiol. Feb 2009;58:155-62. [Medline].

  5. Hall V, Collins MD, Hutson RA, Inganäs E, Falsen E, Duerden BI. Actinomyces oricola sp. nov., from a human dental abscess. Int J Syst Evol Microbiol. Sep 2003;53:1515-8. [Medline].

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