Table 1.
Recommended antibiotic regimes for indicated conditions in the paediatric dental outpatient.
| Oral Infection | Author/s (Year) | Type of Study | Indicated Antibiotic Regime | Indicated Antibiotic Regime in Penicillin-Allergic Patients | Additional Measures | Comments | Quality of the Evidence |
|---|---|---|---|---|---|---|---|
| Acute odontogenic abscess associated with raised axillary temperature and diffuse swelling | Palmer (2006) [22] | Expert opinion | Amoxicillin (2–3 days, max 5 days): <12 months: 62.5 mg tds 1–5 years: 125 mg tds 6–12 years: 250 mg tds Phenoxymethyl penicillin (2–3 days, max 5 days): <12 months: 62.5 mg qds 1–5 years: 125 mg qds 6–12 years: 250 mg qds |
Metronidazole (3 days): 1–3 years: 50 mg tds 3–7 years: 100 mg bid 7–10 years: 100 mg tds >10 years: 200 mg tds Erythromycin (2–3 days, max 5 days): 1 month–2 years: 125 mg qds 2–12 years: 250 mg qds Azithromycin (2–3 days): 6 months–3 years: 10 mg/kg od 3–7 years 200 mg od 8–11 years: 300 mg od 12–14 years: 400 mg od >14 years: 500 mg od |
Remove cause Establish drainage Review 2–3 days |
Author recommends the use of these antibiotics in descending order: amoxicillin, phenoxymethyl penicillin, metronidazole and lastly erythromycin. | Low 1 |
| Cellulitis | SDCEP [23] | Clinical guidelines | Amoxicillin (5 days): 6 months–1 year: 62.5 mg tds 1–5 years: 125 mg tds 6–18 years: 250 mg tds OR Phenoxymethyl penicillin (5 days): 6 months–1 year: 62.5 mg qds 1–6 years: 125 mg qds 6–12 years: 250 mg qds 13–18 years: 500 mg qds |
Metronidazole Tabs, or Oral Suspension for 5 days: 1–3 years: 50 mg tds 4–7 years: 100 mg bid 8–10 years: 100 mg tds 11–18 years: 200 mg tds OR Clarithromycin (7 days): 1–5 years: 125 g bid 6–12 years: 187.5 mg bid 13–18 years: 250 mg bid |
Low 1 | ||
| Generalized aggressive periodontitis and localized aggressive periodontitis | Haas et al. (2008) [24] | RCT | Azithromycin 500 mg coated tablet once daily for 3 days. | Phase 1 consisted of two sessions of supragingival scaling and oral hygiene instructions. At day 15, a clinical examination was performed, and phase 2 started consisting of nonsurgical periodontal therapy with subgingival hand scaling and root planing. Phase 2 was completed within a period of 14 days. The subjects were given azithromycin the first treatment session of phase 2. | Patients were ≥13 years; One year follow up significant improvement. | Very low 2 | |
| Localized aggressive periodontitis | Muppa et al. (2016) [25] | Case report | Amoxicillin (50 mg/kg/day) (body weight in three divided doses) AND metronidazole 30 mg/kg/day for 15 days. | Further topical application of metronidazole in chlorhexidine (Rexidin-M gel) base was advised for 2 weeks. Vitamin B complex syrup was also included. | Child was 5 years old; Regular checkups and motivation for oral hygiene were done for 1½ years. | Very low 3 | |
| Localized Aggressive periodontitis | Beliveau et al. (2012) [26] | Retrospective analysis of clinical trial | 500 mg of amoxicillin and 250 mg of metronidazole three times per day tds for 7 days. | Oral hygiene is mandatory. | Antibiotics were administered immediately after mechanical debridement. | Very low 2 | |
| Merchant et al. (2014) [27] | Clinical trial | Same as above | Dose modified for children less than 40 kg. | Very low 4 | |||
| Seremidi et al. (2012) [28] | Case report | Amoxycillin 50 mg/kg and metronidazole 30 mg/kg tds) for 2 weeks. | The oral health preventive program included oral hygiene instructions and more specifically toothbrushing twice daily with a fluoridated toothpaste, use of dental floss for interdental cleaning, and use of disclosing tablets to increase the effectiveness of plaque removal. Dietary instructions (decrease of sweets intake up to once per day) were also given. In office fluoride application was carried out every 3–4 mοnths. Prescription of 0.2% chlorohexidine mouthrinse for 10 days. | 8-year-old boy; Antibiotics were also administered at the end of the second visit of periodontal therapy which included full mouth scaling and root planing under local analgesia in two visits within a one-week interval. | Very low 3 | ||
| Ulcerative necrotizing periodontitis | SDCEP [23] | Clinical guidelines | 3-day regimen Amoxicillin: 6 months–1 year: 62.5 mg tds 2–5 years: 125 mg tds 6–18 years: 250 mg tds |
3-day regimen Metronidazole: 1–3 years: 50 mg tds 4–7 years: 100 mg bid 8–10 years: 100 mg tds 11–18 years: 200 mg td |
Low 1 | ||
| Pericoronitis | SDCEP [23] | Clinical guidelines | 3-day regimen Amoxicillin: 6 months–1 year: 62.5 mg tds 2–5 years: 125 mg tds 6–18 years: 250 mg tds |
3-day regimen Metronidazole: 1–3 years: 50 mg tds 4–7 years: 100 mg bid 8–10 years: 100 mg tds 11–18 years: 200 mg td |
Low 1 |
RCT: randomized controlled trial; tds: three times daily; qds: four times daily; od: once daily; bid: twice daily. Quality of evidence: GRADE-Working Group [29]. 1 Expert opinion or clinical guidelines; 2 Total sample includes children and adults. Number of children was not stated; 3 Case report; 4 Small sample size (22 participants).