Antibiotics - Bacterial Infections

Question 1

Dental abscess

When are antibiotics required?

Answer 1

Dental abscesses are usually infected with viridans Streptococcus spp. or Gram-negative organisms.

Antibiotics are required only in cases of spreading infection (cellulitis, lymph node involvement, swelling) or systemic involvement (fever, malaise).

Question 2

What should be done in severe infections, associated with dental abscess ?

Answer 2

For severe infections the dose of amoxicillin and phenoxymethylpenicillin should be doubled. Severe infections include those cases where there is extra-oral swelling, eye closing or trismus but it is a matter of clinical judgement. Where there is significant trismus, floor-of-mouth swelling or difficulty breathing, transfer patients to hospital as an emergency.

Question 3

What local measures can be used to treat bacterial infections ?

Answer 3

If pus is present in a dental abscess, drain by extraction of the tooth or through the root canals. If pus is present in any soft tissue, attempt to drain by incision.

Question 4

Name the first-line antibiotics for dental abscesses

Answer 4

1. Amoxicillin
2. Phenoxymethylpenicillin
3. Metronidazole
4. Erythromycin

Question 5

Name the second-line antibiotics for treating dental abscesses.

Answer 5

1. Clindamycin
2. Co-amoxiclav
3. Clarithromycin

Question 6

Amoxicillin dose for dental abscess

Answer 6

Adults

Amoxicillin Capsules, 250 mg Send: 15 capsules
Label: 1 capsule three times daily for 5 days

Children

Amoxicillin Capsules, 250 mg, or Oral
Suspension*, 125 mg/5 ml or 250 mg/5 ml

6 months - 1 year 62.5mg threetimes daily
1-5 years 125 mg threetimes daily
5-18 years 250 mg threetimes daily

Question 7

Phenoxymethylpenicillin dose for dental abscess

Answer 7

Adults

Phenoxymethylpenicillin Tablets, 250 mg
Send: 40 tablets
Label: 2 tablets four times daily

_Children _** ** Phenoxymethylpenicillin Tablets,250 mg, or Oral Solution, 125 mg/5 mlor 250 mg/5 ml

6 months - 1 year 62.5 mg four times daily
1-6 years 125 mg four times daily
6-12 years 250 mg four times daily
12-18 years 500 mg four times daily

Question 8

Metronidazol dose for dental abscess

Answer 8

Metronidazole Tablets, 200 mg
Send: 15 tablets
Label: 1 tablet three times daily

Children

Metronidazole‡ Tablets, 200 mg, or Oral Suspension, 200 mg/5 ml

1-3 years 50 mg three times daily
3-7 years 100 mg twice daily
7-10 years 100 mg three times daily
10-18 years 200 mg three times daily

Question 9

Erythromycin dose for dental abscess

Answer 9

Erythromycin Tablets, 250 mg
Send: 20 tablets
Label: 1 tablet four times daily for 5 days

Children

Erythromycin Tablets, 250 mg, or Oral Suspension*, 125 mg/5 ml

6 months - 2 years 125 mg four times daily
2-18 years 250 mg four times daily

Question 10

Clindamycin dose for dental abscess

Answer 10

Clindamycin Capsules, 150 mg
Send: 20 capsules
Label: 1 capsule four times daily, swallowed with water

Children

12-18 years, same as adults

Question 11

Co-amoxiclav dose for dental abscess

Answer 11

Co-amoxiclav 250/125 Tablets
Send: 15 tablets
Label: 1 tablet three times daily

Children

Same as adults

Question 12

Clarithromycin dose for dental abscess

Answer 12

Clarithromycin Tablets, 250 mg
Send: 14 tablets
Label: 1 tablet two times daily

Children

Clarithromycin Tablets, 250 mg or Oral Suspension 125 mg/5ml or 250 mg/5 ml
1-5 years 125 mg two times daily
5-12 years 187.5 mg two times daily 12-18 years 250 mg two times daily

Question 13

Local managment of ANUG and pericoronitis.

Answer 13

In the case of acute necrotising ulcerative gingivitis, carry out scaling and provide oral hygiene advice.

In the case of pericoronitis, carry out irrigation and debridement.

Question 14

Metronidazole dose for ANUG and Pericoronitis.

Answer 14

Metronidazole Tablets, 200 mg
Send: 9 tablets
Label: 1 tablet three times daily

Children

Metronidazole‡ Tablets, 200 mg, or Oral Suspension, 200 mg/5 ml

1-3 years 50 mg three times daily
3-7 years 100 mg twice daily
7-10 years 100 mg three times daily
10-18 years 200 mg three times daily

Question 15

Amoxicillin dose for ANUG and pericoronitis.

Answer 15

Amoxicillin Capsules, 250 mg
Send: 9 capsules
Label: 1 capsule three times daily

Children

Amoxicillin Capsules, 250 mg, or Oral Suspension*, 125 mg/5 ml or 250 mg/5 ml

6 months - 1 year 62.5mg three times daily
1-5 years 125 mg three times daily
5-18 years 250 mg three times daily

Question 16

Sinusitis; when should antibiotics be administrated and what local measures can be used ?

Answer 16

Sinusitis is a generally self-limiting condition that has an average duration of 2½ weeks. Antibiotic therapy should only be used for persistent symptoms and/or purulent discharge lasting at least seven days or if symptoms are severe.

Local Measure

Advise the patient to use steam inhalation

Question 17

Antibiotics administration and dose, for the treeatment of sinusitis.

Answer 17

Ephedrine Nasal Drops, 0.5%
Send: 10 ml
Label: 1 drop into each nostril up to three times daily when required

Amoxicillin Capsules, 250 mg
Send: 21 capsules
Label: 1 capsule three times daily

Doxycycline Capsules, 100 mg
Send: 8 capsules
Label: 2 capsules on the first day,followed by 1 capsule daily