Odontogenic infections in pediatric patients represent one of the most frequent emergencies in dental practice, particularly involving primary (deciduous) teeth.
These infections can progress rapidly in children due to their developing immune system and anatomical differences, including thinner bone structures and more vascularized oral tissues.
Prompt diagnosis and management are essential to prevent complications such as cellulitis, facial abscesses, or systemic involvement.
Antibiotics play a supportive but critical role in the treatment of these infections, especially when drainage is not feasible, systemic symptoms are present, or the child is immunocompromised.
However, overprescription or inappropriate use of antibiotics in children can lead to increased antimicrobial resistance, adverse drug reactions, and disruptions of the gut microbiota.
Therefore, evidence-based selection of antimicrobial agents is imperative in pediatric dentistry.
This post reviews the three most commonly prescribed antibiotics for odontogenic infections in primary teeth, based on scientific publications from the last five years.
Additionally, it highlights some newer-generation antibiotics and discusses best practices in pediatric antibiotic stewardship.
1. Amoxicillin – The First-Line Choice
Amoxicillin, a broad-spectrum beta-lactam antibiotic, remains the first-line agent for treating odontogenic infections in children without a history of penicillin allergy.
✔ Mechanism of Action: Inhibits bacterial cell wall synthesis.
✔ Pediatric Use: Dosage is adjusted by weight; typically prescribed for 5–7 days.
✔ Clinical Relevance: Effective for localized infections such as dental abscesses and periapical periodontitis.
✔ Supporting Evidence
A 2024 study in Antibiotics (MDPI) revealed that 98% of surveyed pediatric dentists across Europe prefer amoxicillin as a first-line treatment in uncomplicated cases.
► Read also: Pharmacological Management of Pediatric Odontogenic Infections: A Comprehensive Guide for Dental Professionals
2. Clindamycin – For Penicillin-Allergic Children
Clindamycin is widely accepted as the antibiotic of choice in penicillin-allergic pediatric patients.
✔ Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit.
✔ Indications: Recommended for anaerobic infections or patients showing no response to beta-lactams.
✔ Pediatric Use: Dosage varies with age and weight; should be used cautiously due to risk of pseudomembranous colitis.
✔ Clinical Use: Especially effective in abscesses with systemic spread or failed first-line therapy.
✔ Evidence Source
Ministry of Health of Peru emphasizes its utility in odontogenic infections for penicillin-allergic children.
3. Azithromycin – Convenient Alternative with Once-a-Day Dosing
Azithromycin, a macrolide antibiotic, offers a favorable pharmacokinetic profile with once-daily dosing and short treatment courses.
✔ Mechanism of Action: Inhibits protein synthesis at the 50S ribosomal subunit.
✔ Indications: Used when penicillin allergy is present and clindamycin is not tolerated.
✔ Advantages: High tissue penetration, low resistance in children, and minimal gastrointestinal side effects.
✔ Limitations: Resistance development is a concern with overuse; should be reserved for specific indications.
✔ Supporting Literature
The Antibiotics journal also recognizes azithromycin as a viable secondary choice in penicillin-allergic patients.
Newer-Generation Antibiotics in Pediatric Dentistry
Although the above antibiotics remain the most used, some newer-generation antibiotics such as cefdinir, cefpodoxime, or moxifloxacin have shown promise in broader pediatric infection management.
However, their use in dental settings remains limited and must be guided by a pediatric infectious disease specialist due to limited safety data in dental infections.
Clinical Considerations for Pediatric Antibiotic Prescribing
✔ Antibiotics should never replace proper dental intervention, such as drainage or pulp therapy.
✔ Infections without systemic symptoms or spreading should be treated without antibiotics, relying on local management.
✔ Dentists must adhere to pediatric dosing guidelines and consider the shortest effective duration.
✔ Encourage antibiotic stewardship education among dental professionals to reduce misuse.
Conclusion
For professionals in pediatric dentistry, remaining updated with evolving antibiotic guidelines is essential not only for clinical success but also for global efforts in antimicrobial resistance mitigation.
Recommended Guidelines and Scientific References
✔ American Academy of Pediatric Dentistry (AAPD) –
Best Practices for Antibiotic Therapy
✔ Spanish ABE Guide for Odontogenic Infections – Odontogenic Infection in Children
✔ Recent Systematic Review – Antibiotic Use in Pediatric Dental Infections: A European Survey – (MDPI)
