Antibiotic Prescribing.
What's in the Dental Practitioner's Formulary?
The DPF is the list of drugs that UK dentists are allowed to prescribe on the NHS. Dentists are legally allowed to prescribe drugs that are not in the DPF, but this has to be on a private basis.
Phenoxy-methyl-penicillin
Also known as Penicillin V, and Penicillin VK, this is one of the oldest and cheapest antibiotics. It needs to be taken 4 times a day, so compliance can be a problem.
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Available as Phenoxymethylpenicillin Oral Solution BP and Phenoxymethylpenicillin Tablets BP. To be taken by mouth.
For Child 1–11 months: 62.5 mg 4 times a day; increased if necessary up to 12.5 mg/kg 4 times a day.
For Child 1–5 years: 125 mg 4 times a day; increased if necessary up to 12.5 mg/kg 4 times a day.
For Child 6–11 years: 250 mg 4 times a day; increased if necessary up to 12.5 mg/kg 4 times a day.
For Child 12–17 years: 500 mg 4 times a day; increased if necessary up to 1 g 4 times a day.
For Adult: 500 mg every 6 hours, increased if necessary up to 1 g every 6 hours.
Amoxicillin (Amoxil)
Amoxicillin (a type of penicillin) is the mainstay of dental antibiotic treatment. It is taken 3 times a day. It is active against both aerobic and anaerobic bacteria.
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Available as Amoxicillin Capsules BP, Amoxicillin Oral Powder DPF, Amoxicillin Oral Suspension BP. To be taken by mouth.
For Child 1–11 months: 125 mg 3 times a day; increased if necessary up to 30 mg/kg 3 times a day.
For Child 1–4 years: 250 mg 3 times a day; increased if necessary up to 30 mg/kg 3 times a day.
For Child 5–11 years: 500 mg 3 times a day; increased if necessary up to 30 mg/kg 3 times a day (max. per dose 1 g).
For Child 12–17 years: 500 mg 3 times a day; increased if necessary up to 1 g 3 times a day, use increased dose in severe infections.
For Adult: 500 mg every 8 hours, increased if necessary to 1 g every 8 hours, increased dose used in severe infections.
Metronidazole (Flagyl)
Metronidazole is an antimicrobial drug with high activity against anaerobic bacteria. It is useful when the patient is allergic to penicillins. Drinking alcohol while using metronidazole may cause stomach pain, nausea, vomiting, headaches.
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It is available as Metronidazole Oral Suspension BP and Metronidazole Tablets BP. To be taken orally.
For Child 1 month: 7.5 mg/kg every 12 hours usually treated for 7 days.
For Child 2 months–11 years: 7.5 mg/kg every 8 hours (max. per dose 400 mg) usually treated for 7 days.
For Child 12–17 years: 400 mg every 8 hours usually treated for 7 days.
For Adult: 400 mg every 8 hours, alternatively 500 mg every 8 hours usually treated for 7 days.
Azithromycin
Azithromycin is used for patients who are allergic to penicillin, and metronidazole is unsuitable (allergy, or high alcohol intake). It is taken once per day.
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It is available as Azithromycin Capsules 250 mg DPF, Azithromycin Oral Suspension 200 mg/5 ml DPF, Azithromycin Tablets 250 mg DPF and Azithromycin Tablets 500 mg DPF. To be taken by mouth.
For Child up to 17 years (body-weight 46 kg and above): 500 mg once daily for 3 days.
For Adult: 500 mg once daily for 3 days, alternatively initially 500 mg once daily for 1 day, then 250 mg once daily for 4 days.
Clarithromycin
Clarithromycin is also used for patients who are allergic to penicillin, and metronidazole is unsuitable (allergy, or high alcohol intake). It is taken twice per day.
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It is available as Clarithromycin Oral Suspension 125 mg/5 mL DPF, Clarithromycin Oral Suspension 250 mg/5 mL DPF, and Clarithromycin Tablets BP.
For Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily for 5 days.
For Child 12–17 years: 250 mg twice daily for 5 days, alternatively 500 mg twice daily for 5 days.
For Adult: 500 mg twice daily for 5 days.
Tetracyclines
Doxycycline, Tetracycline and Oxytetracycline are in the DPF. These broad-spectrum antibiotics are occasionally used by specialist periodontists on a rare group of patients who have excellent oral hygiene but nevertheless still have active periodontal disease.
Co-amoxiclav
Co-amoxiclav contains amoxicillin and a chemical called clavulinic acid. When combined with penicillins, clavulinic acid can kill many antibiotic-resistant bacteria. Sadly, resistance to co-amoxiclav itself is now common due to over-use. It is a drug of last resort, and it has no place in primary care dental prescribing.
Clindamycin
Clindamycin is also a drug of last resort, and should be reserved to treat serious infections caused by organisms resistant to other antibiotics. It has no place in primary care dental prescribing.
Other antibiotics
The DPF lists three other antibiotics that can be used by dentists, but these are rarely needed. The vast majority of oral infections can be treated with Amoxicillin, Metronidazole, Azithromycin or Clarithromycin
These other antibiotics are Cefalexin, Cefradine and Erythromycin.