Tooth abcess

Case Definition:

A collection of pus due to a bacterial infection of the dental pulp, may spread to the root of the tooth and into the adjacent jaw bone.

 

Diagnostic criteria:

Severe unrelenting toothache, halitosis, dental sensitivity, trismus, swollen gums around the abscess, pyrexia and cervical lymphadenopathy may be present.

 

Severity
(classification)

1st line oral/iv antibiotics

 Penicillin allergy
(see explanatory notes)
A

Minor to moderate infection

Review doses in renal impairment

PENICILLIN V 500mg po qds
Plus
METRONIDAZOLE 400mg po tds

Typical duration: 5 days or 24 hours after tooth removal.

CLARITHROMYCIN 500mg po bd
Plus
METRONIDAZOLE 400mg po tds

Typical duration: 5 days or 24 hours after tooth removal.

B/C

Moderate to severe life threatening infection 

Review doses in renal impairment

BENZYLPENICILLIN 1.2g iv qds
(NB. increase to 2.4g iv qds if severe systemic toxicity)
Plus
METRONIDAZOLE 400mg po tds

 Typical total duration: 5 days

CLINDAMYCIN 1.2g iv qds

 

 

 
Typical total duration: 5 days

IV to Oral Switch (explanatory notes

PENICILLIN V 500mg po qds
Plus
METRONIDAZOLE 400mg po tds

Typical total duration: 5 days

CLINDAMYCIN 450mg qds po

 


Typical total duration: 5 days

Last reviewed 23/04/14

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)