DENTAL INFECTIONS

This guidance is not designed to be a definitive guide to oral conditions. It is for GPs for the management of acute oral conditions pending being seen by a dentist or dental specialist. GPs should not routinely be involved in dental treatment and, if possible, advice should be sought from the patient’s dentist, who should have an answer-phone message with details of how to access treatment out-of-hours.

 

The Scottish Dental Clinical Effectiveness Programme 2016 and other guidance sometimes recommend doses of 250mg amoxicillin or 200mg metronidazole when antimicrobials are appropriate. We recommend a higher dose of 500mg amoxicillin and 400mg metronidazole. The rationale for this is when antimicrobials are considered appropriate, it is important to have sufficient concentrations at the site of infection. For b-lactams such as amoxicillin the killing effect is time-dependent (i.e. the time period above the MIC) and 500mg TDS amoxicillin is more likely to attain this. For metronidazole, the killing effect is dose-dependent and the greater the concentrations above the MIC the better. AUC/MIC >70 is only attainable against Bacteroides fragilis with a 400mg dose.