Antibiotic Decision Making
Effective against most oral organisms including anaerobes, has a low toxicity. and low cost. A loading dose of 1,000mg followed by 500mg every six hours for 7 days (cost $17). Significant portion of population (10%) has some history of allergic reaction.
An analogue of penicillin that is rapidly absorbed and has a longer half-life. Has a higher and more sustained serum level and a slightly larger spectrum. Associated with occasional diarrhea. Usual dose is 1,000mg loading dose followed by 500mg every 8 hours for 7 days (cost $17).
A combination of amoxicillin with clavulanate (inhibitor of enzyme produced by bacteria to inactivate penicillin). Slightly more effective. The usual dosage is 1,000mg loading followed by 500mg every 8 hours for 7 days (cost $87).
Effective against gram-positive aerobic microorganisms and anaerobes. Good choice if a patient is allergic to penicillin. Usual dose is 600mg loading dose followed by 300mg every 6 hours for 7 days (cost $107). Warning of colitis. Rarely seen in short term but inform patient of symptoms.
Don’t offer much more than Penicillin. Possibility of cross allergicity with penicillin. If penicillin allergic history is not severe can use with caution. Usual dose is 1,000mg loading dose followed by 500mg every 6 hours for 7 days (cost $30).
Used in combination with penicillin or clindamycin. It is effective against anaerobes and used when that is expected to be a significant factor, but lacks activity against aerobes. Usual dose is 1,000mg loading dose followed by 500mg every 6 hours for 7 days (cost $32). Patients should not drink alcohol when taking this medicine. Can increase INR for patients on warfarin.
Doesn’t work as well as others. Popular because of long 1/2 life and easy to give once a day. Oral dosage 500mg loading dose followed by 250mg every 12 hours for 6 days (cost $90)
Not effective against anaerobic bacteria, has a poor spectrum, significant GI upset and not used much any more for oral infections.
When treating an infection I consider its history, clinical findings, and the patient’s health. Then I ask myself “at the rate it is progressing what will it look like in 2 or 3 days”, and I then treat that infection. Look for the etiology and remove the cause. The antibiotics may take 48 to 72 hours to get an effective response. Therefore it may be counterproductive to switch antibiotics just because it is not getting better after a day or two. Look to I & D if possible.
Penicillin, Amoxicillin or Clindamycin are still the drugs of choice for oral infections along with removing the etiological cause.
The Palm Beach Center for Oral Surgery and Dental Implants providing quality care to Delray Beach, Boca Raton, Boynton Beach, and Palm Beach County. 561.900.9080 www.PasqualOMS.com