In what situations should I consider prescribing antibiotics for a dental abscess, and which antibiotics are recommended?

Antibiotics should be considered for a dental abscess in clinical situations where the person is systemically unwell, has signs of severe infection (such as fever, lymphadenopathy, cellulitis, or diffuse swelling), or is at high risk of complications (for example, immunocompromised or diabetic patients) ¹.

In the absence of these features, antibiotics are generally not indicated for otherwise healthy people at low risk of complications when there are no signs of spreading infection ¹.

The recommended antibiotics are phenoxymethylpenicillin or amoxicillin, with phenoxymethylpenicillin being the first choice to align with antimicrobial stewardship principles ¹.

If the person has a true penicillin allergy, prescribe metronidazole or a macrolide such as clarithromycin ¹.