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Dental Abscess Medication

  • Author: Jane M Gould, MD, FAAP; Chief Editor: Russell W Steele, MD  more...
 
Updated: Apr 21, 2015
 

Medication Summary

When drainage cannot be achieved or the patient shows signs of systemic involvement, antibiotic therapy is indicated; in addition, an increasing number of immunocompromised patients require antibiotic therapy.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be broad spectrum to cover anaerobes, Staphylococcus aureus, non-typeable Haemophilus influenzae, and others, depending on the context of the clinical setting. The most commonly prescribed antibiotic is amoxicillin/clavulanate.

Penicillin (Pfizerpen, Pen-Vee K)

 

Traditionally been considered the DOC for the treatment of a dental abscess. Antibiotic therapy alone, without surgical drainage, may not be effective because of poor antibiotic penetration into the abscess cavity, ineffectiveness at low pH levels, and the inoculum effect. Bactericidal against sensitive organisms when adequate concentrations are reached and is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects. Binds to one or more penicillin binding proteins, which interferes with bacterial cell wall synthesis during active multiplication. Final transpeptidation step of peptidoglycan synthesis is inhibited leading to death.

Emergence of beta-lactamase producing bacteria may decreased efficacy, although it remains the antibiotic of choice for mild-to-moderate infections.

Azithromycin (Zithromax)

 

May be an option for the treatment of a dental abscess in patients who are allergic to penicillin or beta-lactam. Binds to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, inhibiting bacterial RNA-dependent protein synthesis. Concentrates in phagocytes and fibroblasts, as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Indicated for mild-to-moderate microbial infections.

Metronidazole (Flagyl)

 

Effective against obligate anaerobic organisms. It can be combined with penicillin if anaerobic organisms that produce beta-lactamase enzymes are a concern. Compliance must be considered with a 2-drug regimen. It inhibits DNA synthesis by affecting the helical DNA structure leading to DNA strand breakage causing cell death.

Clindamycin (Cleocin)

 

Can be used in patients who are penicillin or beta-lactam allergic. Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit preventing peptide bond formation. Excellent activity against PO aerobes and anaerobes; penetrates bone and abscess cavities.

Amoxicillin and clavulanate (Augmentin)

 

Amoxicillin works by binding to one or more of the penicillin-binding proteins, which interferes with bacterial cell wall synthesis during active bacterial replication. The final transpeptidation step of peptidoglycan synthesis is inhibited leading to cell death. Clavulanic acid binds and inhibits beta-lactamase enzymes that inactivate amoxicillin resulting in an expanded spectrum of activity for Augmentin. For children, the dosing should be based on the amoxicillin component.

Cefoxitin (Mefoxin)

 

Binds to one or more of the penicillin binding proteins, which interferes with bacterial cell wall synthesis during active replication. The final transpeptidation step of peptidoglycan synthesis is inhibited leading to cell death. It is a second-generation cephalosporin with activity against some gram-positive cocci, gram-negative rods, and anaerobic bacteria. Infections caused by cephalosporin-resistant or penicillin-resistant gram-negative bacteria may respond to cefoxitin.

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Contributor Information and Disclosures
Author

Jane M Gould, MD, FAAP Associate 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, Society for Healthcare Epidemiology of America

Disclosure: Partner received salary from Teva Pharmaceuticals for employment.

Coauthor(s)

Jeffrey J Cies, MPH, PharmD, BCPS Pharmacy Clinical Coordinator, Critical Care Clinical Pharmacist, Infectious Diseases Clinical Pharmacist, St Christopher’s Hospital for Children

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Halim Hennes, MD, MS Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Karen Schneider, MD, to the original writing and development of this article.

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Obvious swelling of the right cheek due to dental abscess.
Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection.
 
 
 
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