Updated Criteria for the Selection of Antibiotic Dosage and Regimen in Dentistry

Antibiotic therapy in dentistry is essential for preventing and treating infections resulting from dental procedures.

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Correct selection of antibiotic dosage and regimen not only ensures therapeutic efficacy but also minimizes the risk of developing bacterial resistance and adverse effects.

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✅ A. Determining Factors in Antibiotic Selection

1. Identification of the Etiological Agent
Odontogenic infections are often polymicrobial, predominantly involving anaerobic and gram-positive aerobic bacteria. Precise identification of the causative agent allows for the selection of an antibiotic with an appropriate spectrum. However, due to the difficulty in isolating and culturing these microorganisms in daily practice, empirical selection based on local epidemiology and the nature of the infection is common.

2. Antibiotic Spectrum
The chosen antibiotic should be effective against the most common pathogens in odontogenic infections. For example, amoxicillin is effective against a wide range of gram-positive bacteria and some gram-negative ones, while clindamycin is preferred in patients allergic to penicillins due to its activity against anaerobes and gram-positive aerobes.

3. Pharmacokinetics and Pharmacodynamics
Understanding the absorption, distribution, metabolism, and excretion of the antibiotic is crucial for determining the dosage and frequency of administration. For instance, amoxicillin has good oral bioavailability and a half-life that allows for administration every 8 hours. Clindamycin, on the other hand, requires administration every 6 to 8 hours due to its shorter half-life.

4. Patient's Condition
The patient's systemic conditions, such as renal or hepatic insufficiency, can affect drug elimination, requiring dosage adjustments. Additionally, in immunocompromised patients, more aggressive or prolonged treatment may be necessary.

5. Possible Interactions and Adverse Effects
It is essential to consider drug interactions, especially in polymedicated patients. For example, erythromycin can interact with other drugs metabolized by the cytochrome P450 system, increasing the risk of toxicity. Moreover, some antibiotics can cause gastrointestinal adverse effects or allergic reactions that must be monitored.

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✅ B. Dosage and Regimen of Common Antibiotics in Dentistry
Below are the dosage and regimen recommendations for the most commonly used antibiotics in dentistry, based on clinical guidelines and recent studies:

1. Amoxicillin
° Indications: Common odontogenic infections.
° Adult dosage: 500 mg orally every 8 hours.
° Pediatric dosage: 20–40 mg/kg/day divided into three doses.
° Considerations: In severe infections, the dose may be increased to 1 g every 8 hours. Dosage adjustment is recommended in patients with renal insufficiency.

2. Amoxicillin/Clavulanic Acid
° Indications: Resistant infections or when beta-lactamase-producing bacteria are suspected.
° Adult dosage: 875 mg/125 mg orally every 12 hours.
° Pediatric dosage: 25–45 mg/kg/day divided into two doses.
° Considerations: The combination with clavulanic acid broadens amoxicillin's spectrum but may increase the incidence of gastrointestinal effects.

3. Clindamycin
° Indications: Patients allergic to penicillins; infections by anaerobes.
° Adult dosage: 300 mg orally every 6–8 hours.
° Pediatric dosage: 8–20 mg/kg/day divided into three or four doses.
° Considerations: Monitor for gastrointestinal side effects and the risk of pseudomembranous colitis.

4. Azithromycin
° Indications: Patients allergic to penicillins; infections by susceptible bacteria.
° Adult dosage: 500 mg once daily for three days.
° Pediatric dosage: 10 mg/kg once daily for three days.
° Considerations: Has a prolonged half-life, allowing for simplified dosing regimens.

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✅ C. Conclusions on the Selection of Antibiotic Dosage and Regimen in Dentistry

1. Evidence-Based Selection: The choice of antibiotics in dentistry should be based on the identification of the etiological agent, appropriate antibiotic spectrum, and updated clinical guidelines to ensure efficacy and safety in treating odontogenic infections.
2. Importance of Pharmacokinetics and Pharmacodynamics: Dosage and regimen should be adjusted considering the drug's absorption, metabolism, and excretion, as well as the patient's systemic condition, to avoid overdosing or bacterial resistance.
3. First-Line Antibiotics and Alternatives: Amoxicillin remains the antibiotic of choice for common dental infections, while clindamycin and azithromycin are safe options for patients with penicillin allergies.
4. Avoiding Antibiotic Abuse and Resistance: Empirical prescription should be prudent, considering the increasing bacterial resistance and the impact of indiscriminate antibiotic use on oral and general microbiota.
5. Individualized Treatment: Each patient should receive personalized antibiotic therapy, taking into account their clinical history, drug interactions, and potential adverse effects to optimize therapeutic response and reduce complications.

In conclusion, the rational use of antibiotics in dentistry is essential for effective infection treatment, minimizing risks, and contributing to the fight against microbial resistance.

📚 References

✔ Bascones Martínez, A., Aguirre Urizar, J. M., Bermejo Fenoll, A., Blanco Carrión, A., Gay Escoda, C., González Moles, M. Á., ... & Llamas Martín, R. (2006). Documento de consenso sobre la utilización de profilaxis antibiótica en cirugía y procedimientos dentales. Avances en Odontoestomatología, 22(1), 43-53.

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Severe Dental Infections: Symptoms, Treatment & Antibiotics

Severe acute dental infections are critical conditions that require immediate attention to prevent serious complications.

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Understanding the nature of dental infections, recognizing their signs and symptoms, identifying common types, and knowing the appropriate treatment protocols, including antibiotic usage and dosages for both adults and children, is essential for effective management

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A. What Is a Dental Infection?
A dental infection, or odontogenic infection, originates within the teeth or surrounding supporting structures and can spread to adjacent tissues if not promptly addressed. These infections typically begin when bacteria infiltrate the dental pulp—the innermost part of the tooth containing nerves and blood vessels—leading to inflammation and the formation of an abscess. Common causes include untreated dental caries (cavities), periodontal disease, or trauma to the tooth.

B. Signs and Symptoms of Dental Infection
Recognizing the early signs and symptoms of a dental infection is crucial for timely intervention. Common indicators include:
° Pain: Persistent, throbbing toothache that may radiate to the jawbone, neck, or ear.
° Sensitivity: Discomfort when consuming hot or cold foods and beverages.
° Swelling: Inflammation in the face or cheek, indicating the spread of infection.
° Fever: Elevated body temperature as the body responds to the infection.
° Swollen Lymph Nodes: Tenderness in the lymph nodes under the jaw or in the neck.
° Difficulty Swallowing or Breathing: Severe cases may lead to swelling that impinges on the throat, necessitating immediate medical attention.
If any of these symptoms are present, it is imperative to seek prompt dental care to prevent the infection from spreading and causing more severe health issues.

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C. Common Severe Acute Dental Infections
° Pericoronitis: This infection occurs around the crown of a partially erupted tooth, often a wisdom tooth. Symptoms include redness, swelling, and pain in the gums. If untreated, it can lead to severe complications like Ludwig's angina or sepsis.
° Acute Dentoalveolar Abscess: A localized collection of pus in the alveolar bone at the root apex of a tooth, typically resulting from untreated dental caries or trauma. Symptoms include intense pain, swelling, and tenderness. Treatment involves drainage of the abscess and addressing the source of infection.
° Cellulitis: A diffuse inflammation of the soft tissues that can spread rapidly, leading to swelling, redness, and severe pain. It may result from untreated dental abscesses and can progress to life-threatening conditions if not managed promptly.

D. Treatment of Dental Infections
The primary goal in treating dental infections is to eliminate the source of infection and prevent its spread. Treatment strategies include:
° Drainage of Abscess: Incision and drainage procedures are performed to release pus and reduce pressure. This can be achieved through root canal therapy or tooth extraction, depending on the severity and location of the infection.
° Antibiotic Therapy: Antibiotics are prescribed to control and eradicate bacterial infections, especially if there are signs of systemic involvement or if the infection is spreading. The choice of antibiotic depends on the severity of the infection, patient age, and any known allergies. It's crucial to follow local guidelines and consult with a healthcare professional for individualized treatment plans.

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E. Commonly Used Antibiotics and Dosages
1. For Adults:
° Amoxicillin: 500 mg every 8 hours or 1,000 mg every 12 hours.
° Clindamycin: 300 mg or 600 mg every 8 hours.
° Metronidazole: 500–750 mg every 8 hours.
2. For Children:
° Amoxicillin:
1–11 months: 125 mg every 8 hours.
1–4 years: 250 mg every 8 hours.
5–11 years: 500 mg every 8 hours.
° Phenoxymethylpenicillin:
1–5 years: 125 mg every 6 hours.
6–11 years: 250 mg every 6 hours.
For severe infections, consider 12.5 mg/kg (max. 1 g) every 6 hours.
° Metronidazole:
1–2 years: 50 mg every 8 hours.
3–6 years: 100 mg every 12 hours.
7–9 years: 100 mg every 8 hours.
10–17 years: 200 mg every 8 hours.
For severe infections or children at extremes of body weight, consider 30 mg/kg (max. 1 g) every 8 hours.

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Conclusions
Effective management of severe acute dental infections involves timely diagnosis, appropriate antibiotic therapy, and, when necessary, surgical intervention. Adhering to recommended antibiotic regimens and dosages is crucial to ensure efficacy and minimize the risk of resistance. Always consider patient-specific factors, such as age, weight, and allergy history, when selecting an antibiotic. Consultation with dental and medical professionals is essential for optimal patient outcomes.

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Appropriate use of antibiotics in pediatric odontogenic infections

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We share updated information on the appropriate use of antibiotics in infectious processes of odontogenic origin in pediatric patients.

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👉 "Use of Antibiotic Therapy for Pediatric Dental Patients" 👈

American Academy of Pediatric Dentistry. Use of antibiotic therapy for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:537-41.

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How to manage dental infections? - Specific pharmacological treatment

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Let us know the causative agents of odontogenic infections and the clinical management and specific pharmacological treatment for each of them.

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Antibiotics in dental infections in children. Which one to use?

The oral cavity presents a flora that can be affected by an infectious process, at which point the flora becomes opportunistic. The use of antibiotics must be reasonable to control infectious processes.

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The administration of drugs must be responsible to avoid antibiotic resistance (ability of a microorganism to resist the effects of a drug). Before prescribing a medication, it is necessary to review and analyze the drug to avoid resistance and other problems such as allergies.

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We share a study that analyzes the characteristics and use of the most widely used antibiotics in pediatric dentistry during a dental infection.

📌 Read and download the article in PDF : Antibiotic use for treating dental infections in children



Cherry, W.R., Lee, J.Y., Shugars, D.A., White, R.P., & Vann, W.F. (2012). Antibiotic use for treating dental infections in children: a survey of dentists' prescribing practices. Journal of the American Dental Association, 143 1, 31-8.

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Are Antibiotics Enough To Treat A Tooth Infection?

Dental caries is a multifactorial infection, with a very high prevalence in the world, which destroys dental tissue and compromises the dental pulp, generating the much feared dental pain.

Night pain is one of the characteristic signs of dental infection and one of the reasons for most consultation in dental emergencies. The evaluation is clinical and radiological to determine the degree of involvement of caries.

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The administration of antibiotics is necessary to control the pain and the evolution of the infection, but is it enough? The answer below...

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Management of antibiotics in odontogenic infections in pediatric dentistry

Odontogenic infections in children spread rapidly in various areas of the head and neck. That is why it is important for the specialist to take immediate action to avoid putting the patient's life at risk.

Antibiotic treatment in pediatric dentistry should be carried out taking into account the pharmacodynamic characteristics of the pediatric patient. The pediatric dentist must know the drug and the recommended doses to avoid adverse reactions or resistance.

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We share two videos on the correct use and management of the most used antibiotics in infections of odontogenic origin in pediatric dentistry.

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Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation

When the pediatric patient presents an oral infection, antibiotics should be administered with the objective of controlling the infection and avoiding serious consequences at a systematic level. The correct management of antibiotics is a challenge for many pediatric dentists.

In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.

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The article that we share offers us a review of the proper use of antibiotics in pediatric dentistry, considerations that we must take into account when prescribing antibiotics, and recommendations to calculate the dose in pediatric dentistry.

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👉 READ AND DOWNLOAD "Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation" IN FULL IN PDF👈

Monika Khoja, et al. Use or Misuse of Antibiotics in Pediatric Dentistry!!!. J Dental Sci 2019, 4(2): 000224.

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Antimicrobial therapies for odontogenic infections in children and adolescents

Oral infections are common in children and adolescents, and treatment must be treated in an effective and timely manner. Infectious processes occur when there is an imbalance in the patient's oral flora.

The use of antibiotics must be rational to avoid drug resistance of microorganisms (microbial resistance). Odontogenic infections can arise from caries or a periodontal problem, sometimes they can be due to dental trauma or iatrogenesis.

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We share a literature review that establishes guidelines for antimicrobial therapy in infections of odontogenic origin and clinical recommendations.

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Guideline on use of antibiotic therapy for pediatric dental patients

👉 Read and download the full article in PDF👈

Antimicrobial therapies for odontogenic infections in children and adolescents. Literature review and clinical recomendations was published in J Oral Res 2014; 3(1): 50-56 (DOI: 10.17126/joralres.2014.013).

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Antibiotic prescriptions in pediatric dentistry: A review

In medicine as well as in dentistry, antibiotics are used as part of infectious treatments, but it is also known that there is a tendency to overuse of this drug for conditions not indicated.

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The consequence of this indiscriminate use of antibiotics is the appearance of resistance in pediatric patients (the ability of bacteria to survive the presence of an antibiotic).

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If we add to this the mismanagement of doses in children, we are facing a serious problem, since we create more resistant bacteria, this currently forces us to adjust the doses of medications.

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The work we are sharing with you is a review that aims to highlight the clinical indications for prescribing antibiotics for orofacial infections in pediatric care.



° Goel, Dhirja & Goel, GauravKumar & Chaudhary, Seema & Jain, Deshraj. (2020). Antibiotic prescriptions in pediatric dentistry: A review. Journal of Family Medicine and Primary Care. 9. 473. 10.4103/jfmpc.jfmpc_1097_19.

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Antibiotics and its use in pediatric dentistry: A review

Antibiotics are commonly used in dentistry for prophylactic as well as for therapeutic purposes. Very often antibiotics are used in unwarranted situations, which may give rise to resistant bacterial strains.

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Good knowledge about the indications of antibiotics is the need of the hour in prescribing antibiotics for dental conditions. The purpose of this review article is to provide information on proper use of antibiotics in pediatric dental practice for control of oral infection, and in the management of children with systemic conditions which may alter disease resistance and healing response.

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Introduction: Antibiotics are among the most frequently prescribed medication for the treatment as well as prevention of bacterial infection in modern medicine. Antibiotics cure disease by killing, injuring, or inhibiting the growth of bacteria at very low concentrations.

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The word antibiotic came from the word “antibiosis” a term coined in 1889 by Louis Pasteur which means a process by which life could be used to destroy life.The term antibiotic was first used in 1942 by Selman Waksman and his collaborators in journal articles to describe any substance produced by a microorganism that is antagonistic to the growth of other microorganisms in high dilution.



° Annamalai, S., & Baghkomeh, P.N. (2018). Antibiotics and its use in pediatric dentistry : A review.

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How To Determine a Child's Medication Dose

Determining the dose in pediatric patients is sometimes complicated, this happens in both medical and dental practice. In pediatric practice medication dosages are calculated based on the child’s weight making the dosages much more precise.

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All the necessary data should be taken to be able to calculate the dose in children. Many take the adult dose as a reference, but this could lead to problems such as poisoning or drug resistance.



This video explains why and teaches you how to do it safely using a simple 4 step method. Thanks to the RN Kid channel that offers us a very simple way to calculate the doses in children

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Guideline on use of antibiotic therapy for pediatric dental patients

The American Academy of Pediatric Dentistry (AAPD) recognizes the increasing prevalence of antibiotic-resistant microorganisms and potential for adverse drug reactions and interactions.

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These recommendations are intended to provide guidance in the proper and judicious use of antibiotic therapy in the treatment of oral conditions. The use of antibiotic prophylaxis for dental patients at risk for infection is addressed in a separate best practices document. Information regarding commonly prescribed antibiotics can be found in Useful Medications for Oral Conditions.

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Antibiotics are beneficial to patient care when prescribed and administered correctly for bacterial infections. However, the widespread use of antibiotics has permitted common bacteria to develop resistance to drugs that once controlled them. Drug resistance is prevalent throughout the world.

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In the United States, at least two million people are infected by antibiotic-resistant bacteria per year. Some microorganisms may develop resistance to a single anti-microbial agent, while others develop multidrug-resistant strains. To diminish the rate at which resistance is increasing, health care providers must be prudent in the use of antibiotics.



Souce: https://www.aapd.org/

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