Antibiotic Recommendations for Endodontic Infections
Primary treatment objectives to manage an endodontic infection are:
- Adequate debridement of the infected root canal
- Achieving drainage for the soft and hard tissues with an “Incise and Drain” procedure.
Antibiotics are considered adjunctive therapy to help manage infections and are indicated only under certain circumstances:
- When there is systemic or regional involvement indicated by fever, malaise, cellulitis and/or lymphadenopathy.
- When the infection is spreading or worsening after the two primary treatment objectives have been achieved.
- When the two primary treatment objectives cannot be rendered.
Under what conditions are antibiotics NOT indicated?
- To manage symptoms in vital cases, i.e. symptomatic irreversible pulpitis
- To manage symptoms in necrotic cases after the two primary treatment objectives have been achieved and there is no systemic involvement.
|Non-Penicillin Allergic patient||Penicillin allergic patient|
|First choice||Amoxicillin, 1000 mg loading dose and then 500 mg TID for 5-7 days||Clindamycin, 600mg loading dose and then 300mg q6h for 5-7 days|
|If no symptom improvement after
|Add Metronidazole, 500 mg q6 h for 7 days||Switch to Azithromycin 500 mg/day, 250 mg days 2-5|
Important things to remember:
- Always review the medical history to check if the patient has any allergy, is immunocompromised, has poorly controlled diabetes, has any metabolic dysfunction or a history of C. difficile that might affect drug choice, dosage, or scheduling
- Re-assess a patient’s status and response to antibiotic therapy 48 hours after initiation and consider switching the drug or adding to a regimen if there is 1) no improvement or worsening or 2) significant GI upset
- C. difficile infection can evolve into pseudomembranous colitis, a potentially life-threatening condition. Signs and symptoms include diarrhea with fever, abdominal pain, and mucous and blood in stool. Refer patient to primary care physician.
- Use a loading dose for the fastest onset and relief
- Keep the duration as short as is effective (usually no longer than 7 days)
- Prescribing Amoxicillin 500mg TID is more effective than 875 BID
- Hypersensitivities or allergies can develop at any time