Spreading odontogenic infections without systemic or severe features
For antibiotic therapy of spreading odontogenic infections without systemic or severe features, use:
Option 1:
Metronidazole 400mg (child: 10mg/ kg up to 400mg) orally, 12 hourly for 5 days. |
PLUS:
Phenoxymethylpenicillin 500mg (child: 12.5mg/kg up to 500mg) orally, 6 hourly for 5 days |
Amoxicillin 500mg (child: 15 mg/kg up to 500mg) orally 8 - hourly for 5 days |
Option 2:
Amoxicillin + clavulanate 875 + 125 mg (child: 2 months or older, 22.5 + 3.2 mg/ kg up to 875 +125 mg) orally, 8 - hourly for 5 days. |
For patients hypersensitive to penicillins
Review patients within 48 - 72 hours of starting treatment.
Clindamycin 300mg (child: 7.5 mg/ kg up to 300mg) orally, 8 hourly for 5 days |
Spreading odontogenic infections with systemic or severe features
Arrange urgent transfer of patients with a spreading infection with severe or systemic features to a hospital that has an oral or maxillofacial surgeon or another appropriate expert. |
Management of spreading infection with severe or systemic features involves:
maintaining a patent airway (do not lie the patient flat)
resuscitation
draining pus by incising affected spaces and placings drains
removing the tooth or otherwise addressing the source of infection
obtaining blood and other samples for oral and susceptibility testing
intravenous antibiotic therapy
For empirical antibiotic therapy of spreading odontogenic infection with severe or systemic feature (including Ludwig angina), in conjunction with surgical intervention, use:
Option 1:
Benzylpenicillin intravenously |
patients not requiring intensive care support: 1.8g (child: 50mg/kg up to 1.8g) 4 - hourly |
patients requiring intensive care support: 2.4g (child: 50mg/kg up to 2.4g) 4 - hourly |
PLUS
Metronidazole 500 mg (child: 12.5mg/kg up to 500mg) intravenously, 12 hourly |
Option 2:
Amoxicillin + Clavulanate intravenously adult: 1 + 0.2g . Child 25 + 5mg/kg up to 1+0.2 g 6 hourly |
For patients with immediate non - severe or delayed nonsevere hypersensitivity to penicillins:
Cefazolin 2g intravenoulsy 8 hourly (for child 50mg/kg up to 2g), for adults requiring intensive care support, use 6 -hourly dosing |
Metronidazole 500mg (child: 12.5mg/kg up to 500mg) intravenously, 12 hourly |
For patients with immediate immediate severe or delayed severe hypersensitivity to penicillins, choose either:
Clindamycin 600mg (child: 15 mg/ kg up to 600mg) intravenously 8 hourly |
Lincomycin 600mg (child: 15 mg/ kg up to 600mg) intravenously, 8 hourly |
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