Dental Abscess Organism-Specific Therapy
Updated: Dec 29, 2020
Author: Jane M Gould, MD, FAAP; Chief Editor: Jeff Burgess, DDS, MSD
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]
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
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 orcefoxitin 1-2g IV q6h orcefotetan 2g IV q12h
Duration of therapy: 7 days
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
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
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
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
For all weight-based pediatric doses listed below,[10] do not exceed adult dose.[9, 11]
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
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
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
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
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
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