Pericoronitis, Antibiotic Prescribing

Antibiotics are rarely indicated in Pericoronitis unless there is pyrexia, spreading infection and/or trismus.

Local Measures

  • Irrigate and debride the stagnation area
  • Relieve occlusion by filing down the opposing tooth or extracting as appropriate

Comments from Expert Advisory Committee

  • Treat pericoronitis in the first instance using local measures to achieve debridement and irrigation of stagnation areas. Antibiotics are only required in the case of spreading infection (cellulitis, lymph node involvement, trismus) or systemic involvement (fever and malaise).
  • Pericoronitis is usually caused by oral gram positive or anaerobic organisms. Metronidazole or amoxicillin are usually effective in treating such infections. The duration of treatment depends on the severity of the infection and the clinical response but drugs are usually given for 3 days.
  • For severe infections consideration should be give to using both amoxicillin and metronidazole in combination. Severe infections include those cases where there is extra-oral swelling, cellulitis or trismus, but it’s a matter of clinical judgement.
  • Where there is significant trismus, floor of the mouth swelling or difficulty breathing, transfer patient to hospital as an emergency.
  • If patient does not respond to the prescribed antibiotic check the diagnosis and consider referral to a specialist.
  • For recurrent pericoronitis consider extraction of the impacted tooth .

Treatment

pericoronitis table 030321_3

Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

Safe Prescribing (visit the safe prescribing page)

  • Doses are oral and for adults unless otherwise stated
  • Penicillin allergy – tips on prescribing in penicillin allergy
  • Renal impairment dosing table
  • Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
  • Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed March 2021

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