An Overview of Evidence-Based Guidelines for Antibiotic Treatment and Prevention in Odontogenic Infections-Current Clinical Perspectives.

Abstract

Introduction: Odontogenic infections can range from localized abscesses to severe sys-temic conditions originating from teeth and their supporting structures. This review outlines evi-dence-based guidelines for selecting antibiotics and using prophylaxis in odontogenic infections, with a focus on prudent use to combat antimicrobial resistance (AMR).

Methods: A narrative review synthesized guidelines from 2015 to 2024 by searching PubMed/PMC, Scopus, Web of Science, and Google Scholar using terms "odontogenic infection, "dental infection," "antibiotic therapy," "antibiotic resistance", and "antibiotic stewardship." The review included clini-cal guidelines, RCTs, systematic reviews, and consensus statements in English, excluding duplicates, non-English articles, and irrelevant studies. The data were analyzed qualitatively.

Results: Antibiotic selection depends on infection severity, patient allergies, comorbidities, and local resistance patterns. For first-line treatment, amoxicillin or phenoxymethylpenicillin is recommended for 3-7 days. For penicillin-allergic patients, clindamycin or a macrolide is recommended. In severe cases, amoxicillin-clavulanate or intravenous options are advised. Prophylaxis is restricted to high-risk cases of Infective Endocarditis (IE). According to ADA, AAOMS, NICE, SDCEP, FDI, and IDA guidelines, narrow-spectrum antibiotics are preferred.

Discussion: Primary measures involve source control, such as drainage and extraction, while antibi-otics serve as adjuncts. Antimicrobial resistance (AMR) is driven by overuse, but stewardship pro-grams (ASPs) and Infection Prevention and Control (IPC) help mitigate it through the use of narrow-spectrum antibiotics, diagnostics, and education. There are gaps in rapid diagnostics and resistance surveillance in dentistry. Although guidelines emphasize prudent prescribing, they differ regionally.

Conclusion: Combining surgical source control with targeted antibiotics enhances outcomes while mitigating AMR. Prophylaxis is designated for patients at high risk of IE. Dentists should follow local antibiograms, educate patients, and implement stewardship to ensure the sustainable manage-ment of odontogenic infections.