While the most important step in managing endodontic infections is prompt treatment by general dentists or endodontists, use of antibiotics when indicated may be necessary in managing certain endodontic emergencies. The American Association of Endodontists (AAE) has recently updated the guidelines for the use of systemic antibiotics for the urgent management of dental infections. The full article can be viewed here.
In summary:
- antibiotics are NOT indicated in immunocompetent patients who have no evidence of lymphadenopathy, fever, malaise, fascial space involvement
- first line of effective antibiotics in endodontic infections: amoxicillin 500mg
- in resistant infections: amoxicillin combined with metronidazole 500mg
- in patients with true allergy to penicillin (i.e., history of anaphylaxis, angioedema or hives): azithromycin 500mg
- in patients with reported allergy to penicillin (i.e. not true allergy): oral cephalexin 500mg
- if patient cannot take azithromycin: clindamycin 300mg
- clindamycin now has U.S. FDA black box warning for C. difficile infection, which can be fatal.
- antibiotic treatment is discontinued as soon as definitive treatment and improvement of the condition occurs (as short as three days).
