Antibiotics are life-saving adjuncts to the armamentarium available to health professionals for management of a plethora of infections. In endodontic treatment and trauma cases, antibiotics are prescribed systemically in the form of either oral and/or, parenteral drugs. Systemic antibiotics are routinely used during treatment of acute and chronic odontogenic infections, oral non-odontogenic infections, as prophylactic treatment against focal infections and infections spreading to the neighbouring tissues and organs. In endodontics, systemic antibiotics have a special role since complete eradication of infection from the root canal is difficult owing to the complex anatomy of the root canals and also, in cases of infections extending into the peri-apical region which eventually result in endodontic flare-ups and failure of endodontic treatment. Antibiotics are, also, commonly given as a life saving drugs in immuno-compromised patients with obvious clinical advantages, in patients suffering with infective endocarditis, septicaemia, pyemia, diabetes mellitus and also, in patients receiving radio-chemo-therapies and patients having prosthetic heart valves. This review comprehensively discusses the role of systemic antibiotics in treatment of endodontic emergencies and promoting healing of the peri-apical infections.