Dental Abscess

Antimicrobial prescribing: NHS Lothian
NHS Lothian

All hospital inpatients with a dental abscess should be referred for inpatient dental review or to maxillofacial surgery.

Severity assessment

Mild infection: 

  • Swelling and erythema present but no signs of severe infection or sepsis.

Severe infection: 

  • Spreading cellulitis
  • Signs of sepsis
  • Difficulty swallowing
  • Difficulty breathing
  • Floor of mouth swelling
  • Trismus

REFER ALL SEVERE CASES TO MAXILLOFACIAL SURGERY

Required investigations

  • Pus from abscess for culture
  • Blood culture (10mls in each bottle)

Antimicrobial recommendations

Recommended total duration: 5 days (mild), 7 days (severe)

  Mild Severe 
Antimicrobial recommendation Phenoxymethylpenicillin 500mg every 6 hours orally

Benzylpenicillin 1.2g every 6 hours IV*

PLUS

Metronidazole 500mg every 8 hours IV
Penicillin Allergy Doxycycline 200mg stat, then 100mg daily orally

Vancomycin (use NHS Lothian Calculator on AMT intranet page) choose trough 15-20 mg/L

PLUS

Metronidazole 500mg every 8 hours IV

*If invasive group A strep or severe/life threatening disease increase frequencing of Benzylpenicillin 1.2g every 4 hours IV 

IV to oral switch

First line

Phenoxymethypenicillin 500mg every 6 hours orally

PLUS

Metronidazole 400mg every 8 hours orally
Penicillin Allergy

Doxycycline  200mg on day one then 100mg daily orally

PLUS

Metronidazole 400mg every 8 hours orally

Notes

Likely organisms: Oral Streptococci and anaerobes