Overview
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. [1] Antibiotics are indicated if drainage is not possible or if the patient shows signs of systemic involvement or is immunocompromised. [2] The duration of therapy should be 7 days. [3, 4, 5, 6, 7]
Organism-specific therapeutic regimens for dental abscess are provided below, including those for Fusobacterium, Bacteroides, Prevotella, Peptostreptococcus, Streptococcus, and Actinomyces. [8]
Specific Organisms and Therapeutic Regimens (Adults)
Fusobacterium
Treatment recommendations are listed below:
-
Penicillin VK 500 mg PO TID or penicillin G potassium 2-4 million U IV/IM q4-6h
-
Up to 50% of Fusobacteriumnucleatum and 20% of Fusobacteriumnecrophorum isolates produce beta-lactamases, making them resistant to penicillin, ampicillin, and some cephalosporins [9]
If penicillin allergic:Clindamycin 300-450 mg PO TID-QID or 600-900 mg IV q6-8h
-
Duration of therapy: 7 days
Bacteroides
Treatment recommendations are listed below:
-
Amoxicillin-clavulanate 500 mg/125 mg PO TID or
-
Amoxicillin-clavulanate 875 mg/125 mg PO BID
-
Some Bacteroides species produce beta-lactamase
If penicillin allergic:
-
Metronidazole 250-500 mg PO TID or cefoxitin 1-2g IV q6h or cefotetan 2g IV q12h
-
Duration of therapy: 7 days
Prevotella
Treatment recommendations are listed below:
-
Amoxicillin-clavulanate 500 mg/125 mg PO TID or
-
Amoxicillin-clavulanate 875 mg/125 mg PO BID
-
Duration of therapy: 7 days
-
Approximately 50% of Prevotella species produce beta-lactamases
If penicillin allergic:
-
Cefoxitin 1-2g IV q6h or metronidazole 250-500 mg PO TID or clindamycin 300-450 mg PO TID-QID or 600-900 mg IV q6-8h
-
Duration of therapy: 7 days
Peptostreptococcus
Treatment recommendations are listed below:
-
Amoxicillin 500 mg PO TID or 1g PO BID or
-
Penicillin VK 250-500 mg PO TID-QID or
-
Penicillin G 2-4 million U IV/IM q4-6h or
-
Clindamycin 300-450 mg PO TID-QID or 600-900 mg IV q6-8h or
-
Cefotetan 2g IV q12h
-
Duration of therapy: 7 days
Streptococcus species
Treatment recommendations are listed below:
-
Amoxicillin 500 mg PO BID or
-
Penicillin V 250-500 mg PO TID-QID or
-
Penicillin G 2-4 million U IV/IM q4-6h or
-
Clindamycin 300-450 mg PO TID-QID or 600-900 mg IV q6-8h or
-
Cefoxitin 1-2g IV q6h or
-
Cefotetan 2g IV q12h
-
Duration of therapy: 7 days
Actinomyces
Treatment recommendations are listed below:
-
Penicillin G 2-4 million U IV/IM q4-6h [7] or
-
Clindamycin 600 mg IV q8h or
-
Doxycycline 100 mg PO BID
-
Duration of therapy: 7 days
-
All Actinomyces isolates are resistant to ciprofloxacin and metronidazole
Specific Organisms and Therapeutic Regimens (Children)
For all weight-based pediatric doses listed below, [10] do not exceed adult dose. [9, 11]
Fusobacterium
Treatment recommendations are listed below:
-
Penicillin VK 25-50 mg/kg/day PO divided TID/QID or
-
Penicillin G potassium 100,000-400,000 U/kg/day IV divided q6h, not to exceed 24 million U/day
-
Up to 50% of Fusobacteriumnucleatum and 20% of Fusobacteriumnecrophorum isolates produce beta-lactamases, making them resistant to penicillin, ampicillin, and some cephalosporins [9]
If penicillin allergic:
-
Clindamycin 30 mg/kg/day PO/IV/IM divided q6-8h or
-
Metronidazole 30-50 mg/kg/day PO or 22.5-40 mg/kg/day IV divided q8h
-
Duration of therapy: 7 days
Bacteroides
Treatment recommendations are listed below:
-
Amoxicillin/clavulanate (dosage based on amoxicillin component)
4:1 dosage form: 20-40 mg/kg/day PO divided q8h, not to exceed 500 mg/125 mg PO TID or
7:1 dosage form: 25-45 mg/kg/day PO divided q12h, not to exceed 875 mg/125 mg PO BID
-
Ampicillin/sulbactam 100-200 mg/kg/day IV divided q6h, not to exceed 4g of ampicillin
-
Some Bacteroides species produce beta-lactamase
If penicillin allergic:
-
Metronidazole 30-50 mg/kg/day PO divided q8h or
-
Cefoxitin 80-160 mg/kg/day IV divided q6h, not to exceed 12 g/day, or
-
Cefotetan 40-80 mg/kg/day IV divided q12h, not to exceed 6 g/day
-
Duration of therapy: 7 days
Prevotella
Treatment recommendations are listed below:
-
Amoxicillin/clavulanate (dosage based on amoxicillin component)
4:1 dosage form: 20-40 mg/kg/day PO divided q8h, not to exceed 500 mg/125 mg PO TID or
7:1 dosage form: 25-45 mg/kg/day PO divided q12h, not to exceed 875 mg/125 mg PO BID
-
Ampicillin/sulbactam 100-400 mg/kg/day IV divided q6h, not to exceed 8 g/d ampicillin
-
Approximately 50% of Prevotella species produce beta-lactamases
If penicillin allergic:
-
Cefoxitin 80-160 mg/kg/day IV divided q6h or
-
Metronidazole 30-50 mg/kg/day PO divided q8h or
-
Clindamycin 30 mg/kg/day PO/IV/IM divided q6-8h
-
Duration of therapy: 7 days
Peptostreptococcus
Treatment recommendations are listed below:
-
Amoxicillin 25-50 mg/kg/day PO divided TID or
-
Penicillin VK 25-50 mg/kg/day PO divided TID/QID or
-
Penicillin G potassium 100,000-400,000 U/kg/day IV divided q6h, not to exceed 24 million U/day, or
-
Clindamycin 30 mg/kg/day PO/IV/IM divided q6-8h or
-
Cefotetan 40-80 mg/kg/day IV divided q12h, not to exceed 6 g/day,
-
Duration of therapy: 7 days
Streptococcus species
Treatment recommendations are listed below:
-
Amoxicillin 25-50 mg/kg/day PO divided TID or
-
PenicillinVK 25-50 mg/kg/day PO divided TID/QID or
-
Penicillin G potassium 100,000-400,000 U/kg/day IV divided q6h, not to exceed 24 million U/day, or
-
Clindamycin 30 mg/kg/day PO/IV/IM divided q6-8h or
-
Cefoxitin 80-160 mg/kg/day IV divided q6h, not to exceed 12 g/day, or
-
Cefotetan 40-80 mg/kg/day IV divided q12h, not to exceed 6 g/day
-
Duration of therapy: 7 days
Actinomyces
Treatment recommendations are listed below:
-
Penicillin G potassium 100,000-400,000 U/kg/day IV divided q6h, not exceed 24 million U/day, or
-
Clindamycin 30 mg/kg/day IV divided q6-8h or
-
Doxycycline (children older than 8 y) 2-4 mg/kg PO once daily or divided BID
-
Duration of therapy: 7 days
-
All Actinomyces isolates are resistant to ciprofloxacin and metronidazole