Acute dentoalveolar infections: an investigation of the duration of antibiotic therapy

Abstract

Objective: To evaluate shortened courses of antibiotics in the management of dentoalveolar abscesses.

Design: Prospective clinical study over a 3-year period.

Setting: Examinations department of the Liverpool University Dental Hospital.

Subjects: 759 patients, with acute dentoalveolar abscesses associated with swelling, and an elevation of axillary temperature to above 38.5 degrees C, were included in the investigation. The minimum age of the patients was 16 years.

Interventions: The initial treatment was to drain the abscess by incision (124 patients), or extraction (635). The patients were prescribed amoxycillin (250 mg every 8 hours), clindamycin (150 mg every 6 hours) or erythromycin stearate (250 mg every 6 hours) and instructed to drink plenty of fluid. All the patients were seen 2 or 3 and 10 days later; only patients who were seen at these times were included in the trial.

Main outcome measures: Resolution of the swelling and a normal axillary temperature.

Results: At first review 748 patients (98.6%) had normal temperatures, marked resolution of the swelling and the antibiotic was discontinued. None of these 748 patients required further antibiotic therapy.

Conclusions: The duration of antibiotic therapy in most patients with acute dentoalveolar infections can safely be 2-3 days, provided that drainage has been established. It is not, therefore, necessary for the majority of patients to complete a 5-day course of antibiotics.