A randomised trial of co-amoxiclav (Augmentin) versus penicillin V in the treatment of acute dentoalveolar abscess

Abstract

In a randomised, operator-blind, comparative clinical trial, the efficacy of co-amoxiclav (250 mg amoxycillin plus 125 mg clavulanic acid, eight-hourly) was compared to that of penicillin V (250 mg phenoxymethylpenicillin, six-hourly) in the treatment of acute dentoalveolar abscess. In each case surgical drainage was established at the time of initial presentation by incision of any soft tissue swelling, accompanied by either extraction of the tooth or extirpation of the pulp as indicated clinically. Each patient recorded the severity of their pain and swelling at eight-hourly intervals using graduated scales. Clinical review was performed after 1, 2 and 5 days of treatment, at which time sublingual temperature was recorded and the presence of cervical lymphadenopathy determined. A total of 79 patients were clinically assessable on Day 5 (co-amoxiclav, n = 41; penicillin V, n = 38). The two groups were comparable for sex, age, presenting features and microbiology. Penicillin-resistant organisms were isolated from five patients (co-amoxiclav, n = 3; penicillin V, n = 2). Symptoms improved in all patients following the start of treatment, however those receiving co-amoxiclav recorded a significantly greater decrease in pain during the second (P = 0.026) and third days (P = 0.025). Only one patient reported a significant adverse effect associated with drug therapy, and this was in the penicillin group. Co-amoxiclav was as effective as penicillin therapy.

The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of acute dentoalveolar abscesses – a review

“…This may be related to the eradication of the betalactamase producers with co-amoxiclav that would not be eradicated by penicillin V. 54 All of these data support the contention that phenoxymethylpenicillin should not be the fi rst choice of antibiotic for dentoalveolar infections.…”

“…34,48,52 Penicillin resistant bacteria are often present in the micro-fl ora of acute dental infections. [53][54][55] Eick et al 57 showed that the majority of micro-organisms isolated from pus from dento-alveolar abscesses were Gram negative anaerobes and were highly susceptible to metronidazole and clindamycin, but that 22% of isolated bacteria produced beta-lactamases and were resistant to penicillin.…”

“…A number of studies have shown that patients respond well when treated with amoxicillin 36,49,[52][53][54]57 despite the evidence of resistant strains and Ingham et al 80 found that metronidazole was as benefi cial as penicillin, surmising that this indicated that the anaerobic population of bacteria were most pathogenic. However it may be that effective drainage to reduce the number of bacteria, promote aerobic conditions and optimise a return to health may be the most important part of the process of abscess resolution.…”

An outcome audit of three day antimicrobial prescribing for the acute dentoalveolar abscess

“…This optimises the therapeutic benefits of the antibiotic to the patient while minimising the risks of increasing microbial resistance. There is increasing evidence that many of the responsible oral flora are becoming resistant to penicillin [59][60][61][62] and a number of studies have advocated the benefits of clindamycin as the first choice antibiotic for dentoalveolar abscess management in patients with evidence of systemic involvement. 24,35,47,62,65,69,71,80 …”

“…[52][53][54] Radical changes in prescribing habits and recognition of the increasing levels of resistant micro-organisms are needed to slow this ever-increasing trend. 8,51,[53][54][55][56][57][58][59][60][61][62] It is now clear that indiscriminate usage of antibiotics has contributed to this massive increase of resistant bacteria. As a consequence the European Centre for Disease Prevention launched the first European Antibiotics Awareness Day on 18 November 2008.…”