Inappropriately prescribing antibiotics is one of the main contributing factors in the development of antibiotic resistant microorganisms.
The most effective treatment of endodontic infections are: removal of the source of infection through endodontic treatment, incision for drainage, or extraction. Antibiotics are used in addition to appropriate treatment to aid the host defenses in the elimination of remaining bacteria.
Antibiotics are INDICATED when there is systemic involvement or evidence of spread of infection. Signs and symptoms include: fever >100F, malaise, cellulitis, unexplained trismus, lymphadenopathy, rapid onset swelling. Antibiotic prophylaxis should also be considered for medically at-risk patients, for prevention of infective endocarditis and delayed prosthetic joint infection.
Antibiotics are NOT INDICATED in: teeth with signs of irreversible pulpitis (hot teeth, cracked teeth, teeth with large decays, etc.), teeth with necrotic pulps and a radiolucency, teeth with a sinus tract, and teeth with localized fluctuant swellings.
What to use? Pen-V-K is the antibiotic of choice for endodontic infections. Metronidazol should be used in combination with Pen-V-K or clindamycin if patient’s symptoms worsen 48-72 hours after the initiation of treatment. Amoxicillin is often used for antibiotic prophylaxis cases. Clindamycin is the antibiotic of choice for patients allergic to penicillins or when a change in antibiotic is indicated. Amoxicillin-Clavulanate should be reserved for unresolved infections and patients who are immunocompromised.