Table 6.1.

Antibiotics Summary
Antibiotic: Antibiotic Doses: Normal/Modified
Penicillin VK:
Pregnancy
Category B
Strength:
250/500mg/tab
1. Normal Dose: 250500mg PO q6h/qid.
Liver Disease: No dose alteration.
Renal Dose determined using serum creatinine (S.Cr) or
creatinine clearance (CrCl).
2. S.Cr. <2.0mg/dL or CrCl >50mL/min: Dispense
normal
dose.
3. S.Cr 2.0mg/dL to Predialysis or CrCl 10
50mL/min:
250500mg q8-12h.
4. Dialysis: 250500 q12-16h.
Liquid Pen VK: Liquid Pen VK is available as 125mg/5mL
or 250mg/5mL strengths.
Either strength can be dispensed as 5mL unit dose,
available in
100mL or 200mL size bottles.
Adult Rx: 250500mg (12tsp, 250mg/5mL), q6h/qid x 5
days.
Penicillin G:
Pregnancy
Category B
Strength:
1.2 MU/injection
1. Normal Dose: 1.2 million units Penicillin G, IM q12h.
2. Patient with Both Liver and Kidney Disease: Use
half the
normal dose.

Amoxicillin (Amoxyl):
Pregnancy
Category B
Strengths: 250/500/
875mg/capsule
1. Normal Dose:
a. 250500mg PO q8h or 500875mg PO q12h x 5days.
b. Amoxicillin Oral Suspension: Powder for oral
suspension is available as trihydrate in 125mg/5mL or
250mg/5mL strengths. Either strength can be dispensed
as
5mL unit dose and is available in 80mL, 100mL, 150mL or
200mL size bottles.
Adult Rx: 250/500mg (12tsp, 250mg/5mL), q8h x 5
days.
c. One-day Rx for severe acute infection: 3g or 6,
500mg capsules twice in 8 hours.
2. Premedication: 2g PO 1h prior to Rx.
3. Kidney Disease:
a. CrCl >30mL/min or a S.Cr <3.3mg/dL:
Dispense the normal dose.
b. CrCl 1030mL/min or S.Cr >3.3mg/dL to
Pre-dialysis: Prolong the interval and avoid the 875mg
tablet: Give 250500mg PO q12h.
c. CrCl <10mL/min or Dialysis:
Prolong the interval and give 250500mg PO q24h after
dialysis.
4. Amoxicillin and Liver Disease: Use normal
Amoxicillin
dose till compensated cirrhosis. Avoid Amoxicillin use in
the
presence of decompensated cirrhosis.
5. Liver and Kidney Disease: Can be used. Use renal
dose

guidelines.
Augmentin:
Pregnancy
Category B
Strength:
250/500mg/capsule
1. Normal Dose: 250/500mg q8h.
2. Kidney Disease: Decrease total daily dose by 50%
with
kidney disease.
(continued)
114 Section II: Pharmacology
Table 6.1. Antibiotics Summary (Continued)
Ampicillin:
Pregnancy
Category B
Strength:
250/500mg/capsule
1. Normal Dose: 250500mg q6h x 5 days.
2. Ampicillin Oral Suspension: Powder for Ampicillin
oral
suspension is available as trihydrate: 125mg/5mL or
250mg/5mL. Either strength is dispensed as 5mL unit
dose in
80mL, 100mL, 150mL, or 200mL size bottles. Ampicillin
oral
suspension is also dispensed as 500mg/5mL; 5mL unit
dose, in
100mL size.
3. Premedication Dose: 2g IV/IM 30 minutes prior to
procedure.
Dicloxacillin:
Pregnancy
Category B

Strength:
250/500mg/capsule
1. Normal Dose: 250500mg qid x 5 days.
2. Kidney Disease: Use 50% of the normal daily dose.
Cephalosporins:
Cephalexin (Keflex):
Strength:
250/500mg/capsule
All Cephalosporins are
Pregnancy
Category B
Cefadroxil
(Duricef):
Strength
250/500mg/capsule
Ceftriaxone
(Rocephin):
Injection
1. Cephalexin (Keflex):
a. Normal Dose: 2501,000mg q6h/qid x 5 days,
maximum 4g/day.
b. Cephalexin Oral Suspension: Powder for Cephalexin
oral suspension is available as monohydrate: 125mg/5mL
or 250mg/5mL, 5mL unit dose, available in 100mL and
200mL size bottles.
Adult Rx: 2501,000mg liquid, q6h/qid x 5 days,
maximum 4g/day.
c. Kidney Disease Dose: q12h or q24h.
2. Cefadroxil (Duricef):
a. Normal Dose: 12g/day in 2 divided doses x 5days.
b. Cephadroxil Oral Suspension: Cephadroxil oral
suspension is dispensed as monohydrate: 125mg/5mL,
250mg/5mL, or 500mg/5mL, available in 50mL and
100mL size bottles.

Adult Rx: Typically, 12g/day liquid, in two divided

doses x 5 days.
3. Premedication Prophylaxis with Cephalexin or
Cefadroxil: 2g PO 1h prior to procedure.
4. Cefazolin (Ancef): 1g IV/IM 30 minutes prior
procedure.
5. Ceftriaxone (Rocephin): 1g IV/IM 30 minutes prior to
the
procedure.
6. Kidney and Liver Disease: All Cephalosporins can be
used with 50% total daily dose reduction.
Clindamycin (Cleocin):
Pregnancy
Category B
Strengths:
150/300mg/tablet
Note: 150/300mg PO is a
static dose;
150/300mg IV/IM is a
cidal dose;
600mg PO or IV/IM is a
cidal dose
1. Normal Dose: 150450mg q6-8h/qid PO x 5 days.
Best to
prescribe the lower dose, 150mg tid or q8h to minimize
adverse side effects.
2. Clindamycin Oral Suspension: Clindamycin as
granules
for oral suspension is dispensed as palmitate: 75mg/5mL
in
100mL size bottle.
1. Adult Rx: 24tsp/dose, tid x 5 days; best to dispense
2tsp/dose, to minimize adverse side effects.
3. Refractory Cases of Periodontal Infection:

600mg/day
x 7 days.
Chapter 6: Odontogenic Infections, Antibiotics, and
Infection Management Protocols 115
Table 6.1. Antibiotics Summary (Continued)
4. Premedication Prophylaxis:
a. 600mg PO 1h prior to treatment.
b. 600mg, IV 30 min before procedure.
5. Hepatitis: No dose change.
6. Cirrhosis: Decrease total daily dose by 50%.
7. Kidney Disease: No dose change with kidney disease
or
renal failure.
8. Kidney and Liver Disease: Can be used with a 50%
total
daily dose reduction.
Azithromycin
(Zithromax/Z-pak):
Pregnancy
Category B
Strength: 250/500/
600mg/immediate
release tablet
Clarithromycin
(Biaxin):
Pregnancy
Category C
Strength:
250/500mg/immediate
release tablet; 500mg
extended-release tablets,
and 125/250mg/5mL
granules for oral
suspension.

Azithromycin:
1. Azithromycin Normal 5-day Dose: 250mg bid or
500mg HS on day one, then 250mg/day for the next 4
days.
2. Azithromycin Normal 3-day Dose: 500mg/day x 3
days.
3. Azithromycin and Kidney Disease: No dose change.
4. Azithromycin and Liver Disease: No dose
adjustments
with mild or moderate liver disease and either reduce
daily
dose or better yet, avoid with severe liver disease.
5. Azithromycin extended-release suspension
(Zmax):
Dispensed as 2g/60mL. The entire 60mL is a onetime
dose.
6. Oral suspension: Liquid Azithromycin is dispensed as
100
or 200mg/5mL liquid.
7. Intravenous preparation: Dispensed as ypholized
Azithromycin 500mg/10mL vial.
Clarithromycin:
1. Clarithromycin Normal Dose: 250 or 500mg bid for
5
days.
2. Clarithromycin and Kidney Disease: Decrease the
total
daily dose by 50%. Best to avoid
3. Clarithromycin and Liver Disease: Can be used
with
normal dose in mild liver disease and dose reduction with
moderatesevere liver disease, only if kidney status is
normal.
Premedication Prophylaxis with Both:

1. Azithromycin or Clarithromycin, 500mg PO 1h prior to

procedure.
Metronidazole
(Flagyl):
Pregnancy
Category B: Metronidazole
is safe after 14 weeks
gestation: Safety prior to
14 weeks has not been
established.
Strength:
250/500mg/capsule
1. Normal Dose: 250mg q6h or 500mg q8h x 5 days.
Best to
give lower dose. (250mg) instead of the 500mg dose, to
minimize dry mouth and metallic taste.
2. Alternate Rx for bacterial Infection: 7.5mg/kg BW
(Max. 1g), q6h x 7 days.
3. Poor Mans Augmentin: 250/500mg Pen
VK/Amoxicillin + Metronidazole 250mg q6h or 500mg q8h
x
5 days.
4. Pseudomembranous Colitis Treatment:
250/500mg
q8h x 14 days. Repeat one more cycle if infection
persists.
5. Kidney Failure/Dialysis: 500mg PO q12h, given after
dialysis.
6. Mild Liver Disease: Normal dose. Moderate/severe
Disease: Use 50% total daily dose.
7. Liver and Kidney Disease: 250mg q12h.
(continued)
116 Section II: Pharmacology
Table 6.1. Antibiotics Summary (Continued)

Tetracycline HCL:
Pregnancy
Category D
Strength: 250/500mg per
capsule
Doxycycline
(Vibramycin):
Pregnancy
Category D
Strength: 50/100mg per
capsule
Tetracycline HCL:
1. Tetracycline HCL Normal Dose: 250mg qid PO on
empty
stomach x 5 days.
2. Tetracycline and Liver/Kidney Disease: Avoid with
liver
or kidney disease or both liver and kidney disease.
Doxycycline:
1. Doxycycline, 100mg/capsule Normal Dose: 200mg
PO 2 hours prior to bed on day one; 100mg, also 2 hours
prior to bed/day for days 210.
2. Doxycycline, 50mg/capsule Normal Dose: 100mg
PO
2 hours prior to bed, on day one; 50mg, also 2 hours prior
to
bed/day for days 210.
3. Doxycycline with Liver/Kidney Disease: Normal
dose.
4. Kidney and Liver Disease: Normal dose.
5. Doxycycline Oral Suspension: Powder for oral
suspension
is dispensed as monohydrate: 25mg/5mL in 60mL size
bottle

in syrup form or 50mg/5mL, in 30mL or 473mL size

bottles.
Adult Rx: 100mg/200mg loading dose, followed by
50mg/100mg/dose liquid Doxycycline x 10 days.
Vancomycin (Vancocin)
HCL Pulvules:
Pregnancy
Category C
Oral Vancomycin:
125/250mg per pulvule
IV Vancomycin:
Pregnancy
Category C
1. Vancomycin HCl pulvules for Pseudomembranous
Colitis: 125mg 4 times/day x 1014 days. Second
recurrence is treated with oral vancomycin tapered over 4
weeks, with or without pulse dosing. Pulse dosing
prescription:
125mg oral Vancomycin is given q2-3 days, for 28
weeks.
2. Vancomycin for Systemic Infections:
7.5mg/kg BW or 500mg1 g IV q6-12h.
Kidney Disease: Avoid.
Liver Disease: No dose change.
Tigecycline:
Pregnancy
Category D
Tigecycline dose: Recommended dose is 50mg every
12 hours
after a 100mg loading dose. If a patient has severe
hepatic
impairment, a dose of 25mg every 12 hours should be
given
after a loading dose of 100mg. Doses are given

intravenously
over 3060 minutes.
Daptomycin:
Pregnancy
Category B
Daptomycin Dose: Daptomycin is given at a dose of
4mg/kg
IV, once daily and dose adjustment is necessary in the
presence
of renal dysfunction.
Linezolid:
Pregnancy
Category C
Linezolid Dose:
Adults: 600mg oral/IV, q12h; Pediatric: 10mg/kg
oral/IV,

United States FDA Pharmaceutical Pregnancy Categories

Pregnancy Adequate and well-controlled human studies have failed to
Category demonstrate a risk to the fetus in the first trimester of pregnancy
A
(and there is no evidence of risk in later trimesters).

Animal reproduction studies have failed to demonstrate a risk to

the fetus and there are no adequate and well-controlled studies
Pregnancy
in pregnant women OR Animal studies have shown an adverse
Category
effect, but adequate and well-controlled studies in pregnant
B
women have failed to demonstrate a risk to the fetus in any
trimester.
Animal reproduction studies have shown an adverse effect on the
Pregnancy
fetus and there are no adequate and well-controlled studies in
Category
humans, but potential benefits may warrant use of the drug in
C
pregnant women despite potential risks.
There is positive evidence of human fetal risk based on adverse
Pregnancy
reaction data from investigational or marketing experience or
Category
studies in humans, but potential benefits may warrant use of the
D
drug in pregnant women despite potential risks.
Studies in animals or humans have demonstrated fetal
Pregnancy abnormalities and/or there is positive evidence of human fetal
Category risk based on adverse reaction data from investigational or
X
marketing experience, and the risks involved in use of the drug in
pregnant women clearly outweigh potential benefits.