Version May 2024
| Clinical entity | Common causative organisms | Antimicrobial regimens |
| Supragingival dental plaque and dental caries prevention | Streptococcus mutans, other streptococci, Actinomyces spp | Fluoride-containing toothpaste (sodium fluoride, 1.1% or stannous fluoride, 0.4%) 2 or 3 times daily AND/OR |
| Fluoride-containing varnishes (sodium fluoride, 5%) applied 3 or 4 times yearly AND/OR | ||
| Chlorhexidine, 0.12% oral rinse | ||
| Chlorhexidine chips | ||
| 25% metronidazole gel* | ||
| Ulcerative or acute necrotizing ulcerative gingivitis/periodontitis¶ | Prevotella intermedia, Fusobacterium spp, Tannerella forsythia, Treponema denticoli, other oral spirochetes | Metronidazole 500 mg PO every 8 hours OR |
| Amoxicillin-clavulanate 875 mg PO every 12 hours or 500 mg PO every 8 hours OR | ||
| Clindamycin 450 mg PO every 8 hours | ||
| Gingivitis | ||
| Acute simple gingivitis¶Δ | Streptococci, Actinomyces spp, spirochetes | Penicillin VK 500 mg every 6 to 8 hours PLUS metronidazole 500 mg PO every 8 hours OR |
| Amoxicillin-clavulanate 875 mg PO every 12 hours or 500 mg PO every 8 hours OR | ||
| Clindamycin 450 mg PO every 8 hours | ||
| Periodontitis | ||
| Stage III or IV adult and juvenile periodontitis◊ | Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia | Amoxicillin 500 mg PO every 8 hours PLUS metronidazole 500 mg PO every 8 hours OR |
| Amoxicillin-clavulanate 875 mg PO every 12 hours or 500 mg PO every 8 hours | ||
| Stage I or II adult periodontitis | Treponema denticoli, other oral spirochetes, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia | Topical minocycline microspheres (Arestin) OR |
| Topical doxycycline hyclate periodontal extended-release liquid (Atridox) | ||
IV: intravenous; MU: million units; PO: by mouth.
* 25% metronidazole gel is not available in the United States and Canada.
¶ We continue antibiotics until oral lesions have healed and pain has subsided, generally 5 to 7 days for gingivitis and 7 to 14 days for periodontitis. Rarely, IV antibiotics may be warranted for patient with intense gingivostomatitis who cannot tolerate oral intake. Appropriate regimens include ampicillin-sulbactam 1.5 to 3 g IV every 6 hours or clindamycin 600 mg IV every 8 hours.
Δ Acute simple gingivitis rarely requires systemic antimicrobial therapy, which are reserved for patients with rapidly advancing disease, severe pain, or an immunocompromising condition.
◊ For patients with penicillin allergies, other options include second- and third-generation oral cephalosporins with metronidazole. Refer to related UpToDate content for other alternative options.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
