Antibiotic Policy

Need for antibiotic policy

 Policy helps to reduce over usage of antibiotics thereby causing antibiotic resistance and
creation of superbug.
 To avoid non coordination of treatment between the specialists.

Principles of Antibiotic therapy

 These strategies are framed on concrete foundation of best existing data of evidence.
 A dose and duration of therapy is recommended; however, it may be subjected to
modification depending on the clinical scenarios by specialists.
 An antibiotic should be advised if and only if there is likely unambiguous clinical
advantage.
 Simple generic antibiotics should be used primarily whenever possible. Avoid broad
spectrum antibiotics when standard and less expensive antibiotics remain effective
 Avoid widespread use of topical antibiotics (especially those agents also available as
systemic preparations).

Hence, Dr. D. Y. Patil Dental College and Hospital prefers to initiate an antibiotic policy and its
implementation.
Prophylactic Antibiotic Therapy
Sr Surgery / Procedure Micro-organisms likely to First line/ Second line/
. be isolated Empirical alternative
No (Presumptive) antibiotics
antibiotics
1. Extraction S. aureus, Amoxicillin 500mg Cefixime 200mg
Streptococcus TDS BD
Streptococcus pyogens 3 days prior to the 3 days prior to the
procedure procedure
2. Minor oral surgery S. aureus, Amoxicillin 500mg Cefixime 200mg
 Third Molar Streptococcus TDS BD
Surgical Streptococcus pyogens 3 days prior to the 3 days prior to the
extraction procedure procedure
 Periapical
surgery
 Transalveolar
extraction
Alveoloplasty
 Frenectomy
 Tongue tie
 Biopsy
3. Major Maxillofacial S. aureus, IV Cefotaxime 1g IV Amoxicillin +
Surgery Streptococcus 1 hr before the Clavulanic acid
 Facial Trauma Streptococcus pyogens, procedure 625mg BD
 Oral Cancer Enterobacteriaceae 1 hr before the
 Cleft Lip/Palate Metronidazole procedure
 Reconstruction 400mg TDS
surgery Tinidazole Amikacin
 Orthognathic 500mg BD 15 mg/kg/day
3 days before the divided IV/IM q8-
Surgeries
procedure. 12hr
 Implant
Surgeries
 Space Infection
 Immunocompr
omised patients
 Subacute
bacterial
endocarditis
 Prosthetic
Heart valve
replacement
 Rheumatic
Heart disease
 Organ
Transplant
patients.
 Prophylactic antibiotic therapy in pediatric dentistry
1 Dental and Soft Tissue Streptococcus Mutans, Amoxicilin Metronidazole and
Trauma in Oral and Streptococcus 35 – 50 mg/kg/day Ofloxacin
Maxillofacial region mitis and Streptococcus In three divided Combination
oralis, Staphylococcus spp, doses 3 days prior (Ofloxacin 10-
Escherichia coli, MRSA the procedure 15mg/kg/day in
two divided doses
3 days prior the
procedure

Metronidazole
40mg/kg/day in
three divided
doses) 3 days prior
the procedure
2 Minor Surgical Streptococcus Mutans, Amoxicilin Cefixime
Procedures eg: Fusobacterium, 35 – 50 mg/kg/day 50 mg/5ml syrup
Frenectomy, Mucocele Bacteroides, Actinomyces In three divided 200 mg tablet
Excision naeslundii, Peptococcus, doses 3 days prior
Actinomyces the procedure 6 months-12 years,
odontolyticus, ≤45 kg: 8
Peptostreptococcus, mg/kg/day in
Selenomonas, single daily dose or
Eubacterium, BD 3 days prior the
Propionibacterium, procedure
Staphylococcus spp,
>12 years, >45 kg:
400 mg/day PO in
single daily dose or
BD 3 days prior the
procedure
3 Traumatic Extractions, Streptococcus Mutans, Amoxiciilin PLUS Clindamycin
accompanied by Staphylococcus spp, Clavulanic Acid 75mg, 150 mg
curettage of Haemophilus 35 – 50 mg/kg/day tablet
granulomatous tissue/ influenzae, Haemophilus In two divided 150mg/5ml syrup
Enucleation of Cyst parainfluenzae, Escherichi doses 3 days prior 75mg/5ml syrup 3
a coli, and Proteus the procedure days prior the
mirabilias, procedure
Enterobacter, Citrobacter,
Klebsiella, Body weight 10 kg
or Pseudomonas or less:
aeruginosa species, Minimum
Fusobacterium, recommended
Bacteroides, Actinomyces dose: 37.5 mg
naeslundii, Peptococcus, orally three times a
Actinomyces day 3 days prior
odontolyticus, the procedure
 Peptostreptococcus,
Selenomonas, Body weight 11 kg
Eubacterium, or more:
Propionibacterium, and 8 to 12 mg/kg
Treponema, MRSA orally per day, in 3
to 4 equally
divided doses 3
days prior the
procedure

PROPHYLACTIC ANTIBIOTIC THERAPY FOR MEDICALLY COMPROMISED

PATIENTS
1. Infective endocarditis Streptococcus viridians (α- Oral – Oral –
hemolytic streptococcus) Adult: Adult:
Streptococcus sanguis, Amoxicillin 2 g 1 Cephalexin 2 g 1
Streptococcusoralis (mitis), hour before the hour before the
Streptococcus salivarius, procedure. procedure.
Streptococcus mutans Pediatric: Clindamycin 600
Gemellamorbillorum Amoxicillin 50 mg 1 hour before
Staphylococci aureus. mg/kg 1 hour the procedure.
before the Azithromycin or
procedure. Clarithromycin 500
mg 1 hour before
Parenteral – the procedure.
Adult: Pediatric:
Ampicillin 2 g IV Cephalexin 50
or IM 30-60 min mg/kg 1 hour
before the before the
procedure. procedure.
Pediatric: Clindamycin 20
Ampicillin 50 mg/kg 1 hour
mg/kg IV or IM before the
30-60 min before procedure.
the procedure. Azithromycin or
Clarithromycin 15
mg/kg 1 hour
before the
procedure.

Parenteral –
Adult:
Cefazoline or
Ceftriaxone 1 g IV
or IM 30-60 min
before the
procedure.
Clindamycin
 phosphate 600 mg
IV or IM 30-60
min before the
procedure.
Pediatric:
Cefazoline or
Ceftriaxone 50
mg/kg IV or IM
30-60 min before
the procedure.
Clindamycin
phosphate 20
mg/kg IV or IM
30-60 min before
the procedure.

2. Diabetes mellitus Streptococci There is no specific Clindamycin PO

Antibiotics may be Anaerobic Gram-positive regimen. 300 mg TDS 3
prescribed for a patient cocci Amoxicillin PO days prior to
with brittle (very Anaerobic Gram-negative 500 mg TDS 3 procedure and
difficult to control) rods days prior to continue the same
diabetes for whom an procedure and regimen for next 2
invasive procedure is continue the same days.
planned but whose oral regimen for next 2 Metronidazole PO
health is poor and the days. 400 mg TDS 3
fasting plasma glucose days prior to
exceeds 200 mg/dL procedure and
continue the same
regimen for next 2
days.
Cephalexin PO 500
mg BD 3 days
before the
procedure and
continue the same
regimen for next 2
days.
3. History of head and S. aureus, Amoxicillin PO Clindamycin 300
neck radiotherapy E. coli, 500mg 1 week mg PO TDS
S. epidermidis, prior to dental starting from 7
P. aeruginosa, extraction / surgery days before the
K.pneumonia, and continue the extraction and
P. mirabilis, same regimen 1 continued for 7
P. vulgaris week after the days after the
procedure. procedure.
4. Human T. pallidum, Co-trimoxazole Cloxacilin 2-4
immunodeficiency C. trachomatis, 960 mg daily either gm /day PO
virus (HIV) N. gonorrhoeae single or divided Azithromycin
S. pneumonia doses for 3 days 500mg
 Methicillin-resistant S. before procedure 3 times per week
aureus (MRSA)
5. Cancer chemotherapy Gram-negatives only Ciprofloxacin Tab. Trimethoprim
E. coli 500mg BD for 7 80 mg + Tab.
P.aeruginosa days Sulphamethoxazole
Klebsiella sp. OR 400 mg OD for 7
Proteus sp. Levofloxacin days.
Enterobacter-serratia 500mg BD for 7 OR
Bacteroides days Tab.
Gram-positive only Trimethoprim 80
S. aureus mg + Tab.
Clostridia Sulphamethoxazole
400 mg 2 tablets 3
times / week.
6. Hematopoietic stem Gram negative bacteria Ciprofloxacin Tab. Trimethoprim
cell or solid organ (especially enteric 500mg BD for 7 80 mg + Tab.
transplantation bacteria) days Sulphamethoxazole
Gram positive cocci OR 400 mg OD for 7
(mainly viridans group Levofloxacin days.
streptococci) 500mg BD for 7 OR
Clostridium difficile days Tab.
Encapsulated bacteria Trimethoprim 80
(Streptococcus mg + Tab.
pneumoniae, Haemophilus Sulphamethoxazole
influenzae, etc.) 400 mg 2 tablets 3
Nocardia times / week.
Gram negative bacteria
(especially enteric
bacteria)
7. Sickle cell anemia S. pneumoniae Pediatric: Amoxicillin
H. influenza Penicillin V 125mg 20mg/kg/day for 3
S. aureus BD for 3 days days
M. tuberculosis Preoperatively and Preoperatively and
E. coli. 2 days post 2 days post
Salmonella species operatively operatively.
N. meningitidis Adult: Or
Penicillin V 250mg Erythromycin
BD for 3 days 250mg BD for 3
Preoperatively and days
2 days post Preoperatively and
operatively 2 days post
operatively.
8. Chronic high dose P. jirovecci, Tab. Trimethoprim Pentamidine
steroid usage Mycobacterium sp 80 mg + Tab. aerosol inhalation
Sulphamethoxazol 300 mg once
e 400 mg OD for 7 monthly.
days.
OR
Tab.
 Trimethoprim 80
mg + Tab.
Sulphamethoxazol
e 400 mg 2 tablets
3 times / week.
9. Bisphosphonate Fusobacterium, Eikenella, Amoxicillin PO Clindamycin 300
therapy Bacillus, Actinomyces, 500mg TDS 1 mg PO TDS
Staphylococcus, week prior to starting from 7
Streptococcus dental extraction / days before the
surgery and extraction and
continue the same continued for 7
regimen + days after the
Metrnidazole PO procedure.
400 mg TDS 1
week after the
procedure.
10. Hemodialysis Coagulase negative Oral – Oral –
S.aureus. Adult: Adult:
S. aureus species resistant Amoxicillin 2 g 1 Cephalexin 2 g 1
to methicillin or hour before the hour before the
vancomycin (MRSA or procedure. procedure.
VRSA). Pediatric: Clindamycin 600
Enterococci. Amoxicillin 50 mg 1 hour before
Gram negative bacteria. mg/kg 1 hour the procedure.
S. pneumoniae before the Azithromycin or
procedure. Clarithromycin 500
mg 1 hour before
Parenteral – the procedure.
Adult: Pediatric:
Ampicillin 2 g IV Cephalexin 50
or IM 30-60 min mg/kg 1 hour
before the before the
procedure. procedure.
Pediatric: Clindamycin 20
Ampicillin 50 mg/kg 1 hour
mg/kg IV or IM before the
30-60 min before procedure.
the procedure Azithromycin or
Vancomycin 20mg Clarithromycin 15
/kg/week mg/kg 1 hour
AND before the
Gentamycin 1- procedure.
2mg/kg/HD

Parenteral –
Adult:
Cefazoline or
Ceftriaxone 1 g IV
or IM 30-60 min
 before the
procedure.
Clindamycin
phosphate 600 mg
IV or IM 30-60
min before the
procedure.
Pediatric:
Cefazoline or
Ceftriaxone 50
mg/kg IV or IM
30-60 min before
the procedure.
Clindamycin
phosphate 20
mg/kg IV or IM
30-60 min before
the procedure.
Cefazoline 2-3
gm /HD
Cephalosporins should not be used in patients with immediate-type hypersensitivity reaction (urticaria, angioedema

or anaphylaxis) to penicillins.

Total children’s dose should not exceed adult dose.

IM: Intramuscular; IV: Intravenous; HD: hemodialysis; PO: Peroral.

Therapeutic Antibiotic Therapy

S Conditions Micro-organisms likely First line/ Empirical Second line/
r. to be isolated (Presumptive) alternative
N antibiotics antibiotics
o
1. Irreversible Streptoccocus, Amoxicillin-500mg Erythromycin-
Pulpitis Enterococcus, TDS for 5 days 250mg QID for 5
Bacteroides, days
Staphylococcus
epidermidis)
2. Periapical S. viridans, Amoxicillin- clavulanic Azithromycin-
infections- Peptostreptococcus spp, acid 625 mg /875 mg 500mg OD for 5
Periapical Prevotella intermedia, TDS for 5 days days
abscess Porphyromona gingivalis
Periapical and Fusobacterium Amoxicillin -500mg Clindamycin-
granuloma nucleatum, Treponema Metronidazole 400 mg 300mg TID for 5
Periapical TDS for 5 days days
cysts
Ciprofloxacin-
500mg BID for 5
days

Cephalexin
500mg TDS for 5
days
3. Acute P. Intermedia, Amox 500mg TDS for Ofloxacin 200 mg
necrotizing Fusobacterium, 5 days + Metro 400mg + Ornidazole 500
Ulcerative Treponema, Spirochetes TDS for 5 days mg BD for 5 days
Gingivitis
4. Pericoronitis Peptostreptococcus Amox 500mg TDS for Ofloxacin 200 mg
micros 5 days + Metro 400mg + Ornidazole 500
Porphyromonas TDS for 5 days mg BD for 5 days
gingivalis
Fusobacterium spp
Eubacterium spp
Bifidobacterium spp
Actinomyces spp
5. Chronic Porphyromonas Amox 500mg TDS for Ciprofloxacin 500
Periodontitis gingivalis 5 days + Metro 400mg mg + Tinidazole
Tannerella forsythensis TDS for 5 days 600 mg BD for
A.actinomycetemcomotan 5days
s
Peptostremtococcus spp OR
Prevotella intermedia Azithromycin 500 mg Clarithromycin
P. nigrescens OD for 3 days followed 500 mg BD for 5
Fusobacterium nucleatum by Azithromycin 250 days
mg BD for 2 days
Clindamycin-
300mg BD for 5
days
6. Aggressive A. Actinomycetecomitan Amoxicillin- clavulanic Azithromycin 500
Periodontitis P. gingivalis acid 625 mg BD for 5 mg OD for 3 days
days followed by
Azithromycin 250
Ciprofloxacin 500 mg mg BD for 2 days
BD for 5 days

OR Doxycycline 100
mg BD loading
Levofloxacin 500 mg dose
BD for 5 days & 100 mg OD for
15-21 days

7. Amox 500mg TDS for Azithromycin 500

5 days + Metronidazole mg OD for 3 days
P.gingivalis, T.denticola, 400mg for 5 days followed by
Scaling and T.forsythia, Azithromycin 250
Root Planing A.actinomycetecomitans mg BD for 2 days
(Periodontitis
Cases) Ciprofloxacin 500 mg OR
+ Tinidazole 600 mg Clarithromycin
BD for 5 days 500 mg BD for 5
days

Clindamycin-
300mg BD for 5
days
8.
Amoxicillin 500 mg Ofloxacin 200 mg
Periodontal F. nucleatum, P. TDS for 5 days + + Ornidazole 500
Abscess intermedia, P. gingivalis, Metronidazole 400 mg mg BD for 5 days
drainage P. micros, and B. TDS for 5 days
forsythus.
OR Azithromycin 500
mg OD for 3 days
Ciprofloxacin 500 mg followed by
+ Tinidazole 600 mg Azithromycin 250
BD for 5 days mg BD for 2 days
9.
S. sanguis, S. mitis, S. Amoxicillin 500 mg Ciprofloxacin 500
intermedius, S. oralis, A. TDS for 5 days mg BD for 5 days
Crown viscosus, A. naeslundii,
Lengthening and Peptostreptococcus
micros. Clindamycin-
300mg BD for 5
days
10.
S. sanguis, S. mitis, S. Amoxicillin 500 mg Ciprofloxacin 500
 intermedius, S. oralis, A. TDS for 5 days mg BD for 5 days
Gingivectomy/ viscosus, A. naeslundii,
Gingivoplasty and Peptostreptococcus
micros. Clindamycin-
300mg BD for 5
days
11. Frenectomy S. sanguis, S. mitis, S. Amoxicillin 500 mg Ciprofloxacin 500
intermedius, S. oralis, A. TDS for 5 days mg BD for 5 days
viscosus, A. naeslundii,
and Peptostreptococcus
micros. Clindamycin-
300mg BD for 5
days
12.
Amoxicillin 500 mg Ciprofloxacin 500
S. sanguis, S. mitis, S. TDS for 5 days mg BD for 5 days
intermedius, S. oralis, A.
Flap surgery viscosus, A. naeslundii,
and Peptostreptococcus Clindamycin-
micros. 300mg BD for 5
days
13.
Amoxicillin 500 mg Ciprofloxacin 500
S. sanguis, S. mitis, S. TDS for 5 days mg BD for 5 days
Mucogingival intermedius, S. oralis, A.
surgery viscosus, A. naeslundii,
and Peptostreptococcus Clindamycin-
micros. 300mg BD for 5
days
14.
Amoxicillin 500mg+ Ciprofloxacin 500
P.gingivalis, T.denticola, clavulanic acid 125mg mg BD for 5 days
Implant T.forsythia, S. sanguis, S. BD for 5 days
surgery mitis, S. intermedius, S. Clindamycin-
oralis, A. viscosus, A. 300mg BD for 5
naeslundii days
15.
Fusobacterium species, Ofloxacin 200 mg
C. albicans, P. Amoxicillin- clavulanic + Ornidazole 500
intermedia, acid 625 mg BD for 5 mg BD for 5 days
Peri Capnocytophaga species, days + metronidazole
implantitis actinomycetemcomitans, 400mg TDS for 5 days Ciprofloxacin 500
treatment Staphylococcus, P. mg + tinidazole
micros, W. recta, 600 mg for 5 days
, Pseudomonas
aeuroginosa, Azithromycin 500
K. pneumoniae, E. coli, mg OD for 3 days
E. aerofaciens, E. cloacae followed by
Azithromycin 250
 mg BD for 2 days
16.
Amoxicillin 500mg+ Ciprofloxacin 500
P.gingivalis, T.denticola, clavulanic acid 125mg mg for 5 days
Implant T.forsythia, S. sanguis, S. for 5 days
surgery with mitis, S. intermedius, S.
augmentation oralis, A. viscosus, A. Cefixime 200 mg
naeslundii Amoxicillin 500mg + for 5 days
metronidazole 400mg
for 5 days
17. Space S.aureus, IV Amoxicillin 1000 IV Ceftriaxone 1g
infection Streptococcus mg + Clavulanic acid BD for 5 days
Streptococcus pyogens, 200 mg for 5 days
Enteroacteriaceae
18. Osteomyelitis S.aureus, IVAmoxicillin 1000 IV Ceftriaxone 1g
Streptococcus mg + Clavulanic acid BD for 5 days
Streptococcus pyogens, 200 mg for 5 days
Enteroacteriaceae IV Amikacin
750mg BD for 5
days
19. Surgical site S.aureus, IVAmoxicillin 1000 IV Ceftriaxone 1g
infection Streptococcus mg + Clavulanic acid BD for 5 days
Streptococcus pyogens, 200 mg for 5 days
Enteroacteriaceae IV Amikacin
750mg BD for 5
days

IV Inj
Vancomycin 1g
BD (infusion) for
5 days
20. Severe Topical chlorhexidine Piperacillin-
mucositis in (0.1%) mouth rinses tazobactam 3.375
immunocompr TID plus one of the g IV q4h for 5
omised host following: days
Cefotaxime 2 g IV q6h
for 5 days Imipenem 500 mg
IV q6h for 5 days
Amoxicillin- Meropenem 1 g
clavulanate 1.2 g for 5 IV q8h for 5 days
days

21. Sialadenitis Facultative bacteria Nafcillin 2 g IV q4h for Vancomycin 1 g

and Str. pneumoniae 5 days IV q12h plus for
suppurative Str. pyogenes plus 5 days
parotitis S. aureus Metronidazole 0.5 g IV
H. influenzae Clindamycin 600
q6h for 5 days
E. coli mg IV q6h for 5
 Haemolytic streptococci days
Anaerobic bacteria
Peptostreptococcus sp.
Pept. magnus
Pept. intermedius
Pept.anaerobius
Actinomycesisraelii
Propionbacterium acnes
Eubacteriumlentum
Fusobacterium sp.
F. nucleatum
Bacteroides sp.
B. fragilis
Pr. melaninogenica
Pr.intermedia
Porphyromonasasaccharo
lytica
22. Noma Fusobacterium Penicillin G 2-4 MU IV Clindamycin 450
necrophorum q4h plus metronidazole mg PO q6-8h or
Prevotella intermedia 500 mg PO or IV q8h 600 mg IV q6-8h
alpha-hemolytic for 5 days for 5 days.
streptococci
Ampicillin-sulbactam
Actinomyces spp.
1.5-3 g IV q6-8h for 5
Veillonella parvula
Staphylococcus aureus days.
Pseudomonas spp.
Amoxicillin-
clavulanate 500 mg PO
q8h for 5 days

23.
Placement of S.Aureus, Amoxicillin Augmentin
TADs/ Bone
screws Sreptococcus Pyogens 500mg TID for 5 days 625mg BID for 5
days

Amox + Metro

500mg + 400mg
TID for 5 days
24. HSV stomatitis Herpes simplex 1 Normal Hosts Valacyclovir 1 g
Acyclovir 200 mg PO 5 PO q12h for 7 day
times daily for 7 days Immunocompromis
Immunocompromised ed Hosts
Hosts foscarnet 40 mg/kg
Acyclovir 250 mg/m2 IV IV q8h for 7 days
q8h or foscarnet 40
mg/kg IV q8h for 7 days
25. Oropharyangeal Candida albicans Nystatin oral suspension Itraconazole 200
candidiasis (100,000 units/mL), rinse mg PO daily x 7-10
with days
5 Clotrimazole troches, Fluconazole 200
10 mg QID x 7-10 days mg PO or IV daily
x 7-10 days
or Voriconazol 200
mg PO (3 mg/kg
IV) q12h x 7-10
days

Therapeutic antibiotic therapy for pediatric dentistry

1. Dental and Soft Streptococcus Mutans, Amoxicilin Metronidazole
Tissue Trauma Streptococcus 35 – 50 mg/kg/day and Ofloxacin
in Oral and mitis and Streptococcus In three divided doses 3 Combination
Maxillofacial oralis, days prior the (Ofloxacin 10-
region Staphylococcus spp, procedure 15mg/kg/day in
Escherichia coli, two divided doses
MRSA 3 days prior the
procedure

Metronidazole
40mg/kg/day in
three divided
doses) 3 days
prior the
procedure
2. Minor Surgical Streptococcus Mutans, Amoxicilin Cefixime
Procedures eg: Fusobacterium, 35 – 50 mg/kg/day 50 mg/5ml syrup
 Frenectomy, Bacteroides, In three divided doses 3 200 mg tablet
Mucocele Actinomyces days prior the
Excision naeslundii, procedure 6 months-12
Peptococcus, years, ≤45 kg: 8
Actinomyces mg/kg/day in
odontolyticus, single daily dose
Peptostreptococcus, or BD 3 days
Selenomonas, prior the
Eubacterium, procedure
Propionibacterium,
Staphylococcus spp, >12 years, >45
kg: 400 mg/day
PO in single daily
dose or BD 3 days
prior the
procedure
3. Traumatic Streptococcus Mutans, Amoxiciilin PLUS Clindamycin
Extractions, Staphylococcus spp, Clavulanic Acid 75mg, 150 mg
accompanied by Haemophilus 35 – 50 mg/kg/day tablet
curettage of influenzae, Haemophilu In two divided doses 3 150mg/5ml syrup
granulomatous s days prior the 75mg/5ml syrup 3
tissue/ parainfluenzae, Escheri procedure days prior the
Enucleation of chia coli, and Proteus procedure
Cyst mirabilias,
Enterobacter, Citrobact Body weight 10
er, Klebsiella, kg or less:
or Pseudomonas Minimum
aeruginosa species, recommended
Fusobacterium, dose: 37.5 mg
Bacteroides, orally three times
Actinomyces a day 3 days prior
naeslundii,Peptococcus, the procedure
Actinomyces
odontolyticus, Body weight 11
Peptostreptococcus, kg or more:
Selenomonas, 8 to 12 mg/kg
Eubacterium, orally per day, in
Propionibacterium, and 3 to 4 equally
Treponema, MRSA divided doses 3
days prior the
procedure
4. Gingivitis Streptococcus, Chlorhexidine gluconate, No antibiotic
Fusobacterium, > 8 years , rinse with should be
Actinomyces, 15ml 2 times daily (after prescribed except in
Veillonella, breakfast and before bed) cases of chronic
Treponema for 30 secs and periodontitis and
expectorate. acute necrotizing
ulcerative gingivitis
5. Abscess with Anaerobic cocci, Amoxicillin >3 months Clindamycin 20-30
systemic prevotella, fusobacterium, <40kg 20-40 mg/kg/day, mg/kg/day in
 involvement) facultative anaerobes, 8 hourly, (max single
streptococcus anginosus dose 500 mg) or 25-45
group mg/kg/day, 12 hourly
( max single dose 875
mg)
Abscess (without
systemic NO
involvement &
draining sinus)
6. Cellulitis and Hemolytic streptococcus, Amoxicillin,
space infections streptococcus >3 months of age and less
pneumoniae, than 40 kg- 20-40
staphylococcus aures mg/kg/day , 8 hourly,
>40kg- 250-500 mg 8
hourly.
OR
phenoxymethyl penicillin
(2-3 days, 5 days max)
for children under 12
years – 25-50 mg/kg/day,
6 hourly, > 12 years 250-
500 mg 6 hourly.
7. Herpetic Herpes simplex type-1, Acyclovir
gingivostomatitis Herpes simplex type -2, for infants,children,
Varicella-zoster virus, adolescents
cytomegalovirus, Epstein- 20mg/kg/dose
barr virus. 4 times daily for 5-7 days
(max single dose 800mg)
8. Herpes labialis Herpes simplex type-1 Acyclovir for infants and
children, 20mg/kg/dose-
4 times daily for 7-10
days or until clinical
resolution
(max single dose 400 mg)
Adolescents- 400 mg 3
times daily for 5-10 days
or until clinical resolution
divided doses every
8 hours
NO
for penicillin
allergic patients’
metronidazole (3
days) 30 mg/kg/day
in divided doses 6
hourly or
azithromycin for
children >6 months
upto 16 years 5-
12mg/kg daily for 3
days or
Clarithromycin
(7days) 7.5 mg/kg
12 hourly
Valcyclovir for
infants> 3 months,
children,
adolescents
20mg/kg/dose 2
times daily for 5-7
days (max single
dose 1000mg)
Valcyclovir
children equal or
above 12 years
2000mg, 12 hourly
for 1 day ( 2 doses)
(max daily dose to
not exceed 4000mg
for 1 day regimen)