Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

Which Antibiotic to Prescribe?

The last week in August, my family and I took a family vacation. While having a casual dinner at a local restaurnant, we struck up a conversation with the family at the next table. He was an attorney and she was a dentist from New Jersey. After the ususal small talk about kids, vacation and the challenges of the private practice of both law and dentistry, the husband asked, "what's new in oral surgery and how do you treat an absessed tooth" ? I promptly answered, "I prescribe Pen VEE "K" 500mg. tablets Q.I.D."

His question prompted me to search the literature for my recent antibiotic studies when I returned from my vacation. Antibiotics are widely used for the treatment of endodontic abcscesses. The choice of antibiotics is based upon reports of susceptibility testing and clinical experience. An updated study of antibiotic susceptibility of bacteria isolated from endodontic abscesses proved to be of interest to me.

Susceptibility values for the antibiotics tested were:

Penicillin V 85%
Clindamycin V 96%
Metronidazole V 45%
Pen V and Metronidazole 93%
Amoxicilin and Metronidazole 99%

Clarithromycin (Zithromax) was also efficacious, but its endpoint not determined.

Based on susceptibility of bacteria, Pen V is still the antibiotic of choice for the treatment of endodontic abcesses. It is a narrow spectrum, inexpensive antibiotic with minimal side effects. Clindamycin is a good choice for penicillin-allergic patients, although it has a wider spectrum, associated with more side effects, and is more costly. Clarithromycin provides an alternative to Erythromycin for patients with a mild infection who cannot take penicillin.

In this era of more and more potent antibiotics, it is most important to prescribe an appropriate antibiotic for the endodontically abscessed tooth.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍