MOUTH - Dental Infections (Viridans streptococci, Group A Streptococcus, naerobes)
Penicillin V Potassium (Pen-Vee K^®) Generics available Pregnancy: B; Lactation: Unsafe Tabs: 125 mg, 250 mg, 500 mg Oral Susp: 125 mg/5 mL, 250 mg/5 mL Strongly consider adding metronidazole for moderate to severe infection.	Children <12 years: 25-50 mg/kg/day (max 2 g/day) in divided doses every 6 hours for 10-14 days. 125 mg/5 mL @ 25 mg/kg/day 10 kg (22 lb) = ^1/2 tsp (2.5 mL) Q6H 15 kg (33 lb) = ^3/4 tsp Q6H 20 kg (44 lb) = 1 tsp (5 mL) Q6H >20 kg (44 lb) = Use adult dose. 250 mg/5 mL @ 50 mg/kg/day 10 kg (22 lb) = ^1/2 tsp (2.5 mL) Q6H 15 kg (33 lb) = ^3/4 tsp Q6H 20 kg (44 lb) = 1 tsp (5 mL) Q6H >20 kg (44 lb) = Use adult dose. Children ³12 years to Adult: 250 mg PO four times daily or 500 mg PO two to three times daily for 7 days.	Food: Take 1 hour before or 2 hours after meals. May take with food if GI upset occurs. Important side effects: Nausea, rash. Use with caution if history of seizures.
Metronidazole* (Flagyl^®) Generics available Pregnancy: B; Lactation: Unk Tabs: 250 mg, 500 mg Use in conjunction with penicillin.	Children: 30 mg/kg/day in divided doses 3 or 4 times daily (max 4 g/day) 10 kg (22 lb) = ^1/2 tsp (2.5 mL) Q6H 15 kg (33 lb) = ^3/4 tsp Q6H 20 kg (44 lb) = 1 tsp (5 mL) Q6H Adult: 250-500 mg PO every 6 hours x 7 days	Food: Administer on empty stomach unless GI upset occurs, then with food. Important side effects: Dizziness, headache, confusion, seizures, nausea, metallic taste, insomnia, paresthesias. Avoid alcohol. Use with caution in persons with history of seizure disorder.
Amoxicillin Amoxil^®, Trimox^® Generics available Pregnancy: B; Lactation: Safe Caps: 250 mg, 500 mg Tabs: 500 mg, 875 mg Chewable Tab: 125 mg, 200 mg, 250 mg, 400 mg Oral Susp: 50 mg/mL 125 mg/5 mL 250 mg/5 mL 200 mg/5 mL 400 mg/5 mL	Neonates and infants ≤3 months: 20-30 mg/kg/day in divided doses Q12H. Children >3 months: 25-50 mg/kg/day (max 2-3 g/day) in divided doses Q8H or Q12H. 250 mg/5 mL at 50 mg/kg/day 10 kg (22 lb) = 1 tsp (5 mL) Q12H 15 kg (33 lb) = 1 tsp (5 mL) Q8H 20 kg (44 lb) = 2 tsp (10 mL) Q12H >25 kg = Use adult dose. Adult: 250-500 mg PO Q8H or 500-875 mg PO Q12H x 7 days	Food: May take with or without meals. Important side effects: Nausea, vomiting, diarrhea, agitation, seizures, rash, bleeding abnormalities, decreased WBC count, drug fever, superinfection. Caution: May cause nonallergic maculopapular rash, especially in patients with viral infection, infectious mononucleosis, or acute lymphocytic leukemia. Reduce dose in renal disease: CrCl 10-30 mL/min administer every 12 hours CrCl <10 mL/min administer every 24 hours
Amoxicillin/clavulanate Augmentin^® Pregnancy: B; Lactation: Unk Q12H Formulations: Tabs: 500 mg/125 mg 875 mg/125 mg Chewable Tabs: 200 mg/28.5 mg 400 mg/57 mg Oral Susp: 200 mg/28.5 mg/5 mL 400 mg/57 mg/5 mL Q8H Formulations: Tabs: 250 mg/125 mg 500 mg/125 mg Chewable Tabs: 125 mg/31.25 mg 250 mg/62.5 mg Oral Susp: 125 mg/31.25 mg/5 mL 250 mg/62.5 mg/5 mL	Dosing: Based on Amoxicillin Component x 7 day treatment Neonates and infants <3 months: 125 mg/5 mL suspension 30 mg/kg/day in divided doses Q12H. Children ≥3 months up to 40 kg: Oral Suspension or Chewable Tablet 25-45 mg/kg/day in divided doses Q12H using a Q12H formulation. 20-40 mg/kg/day in divided doses Q8H using a Q8H formulation. Children ≥40 mg to Adult: 500 mg PO Q12H x 7 days. Q12H using 200 mg/5 mL susp or 200-mg chewable tablet @ 45 mg/kg/day 9 kg (20 lb) = 1 tsp (or tab) (5 mL) Q12H 13 kg (29 lb) = 1^1/2 tsp (or tab) (7.5 mL) Q12H 18 kg (40 lb) = 2 tsp (or tabs) (10 mL) Q12H Q12H using 400 mg/5 mL susp or 400-mg chewable tablet @ 45 mg/kg/day 18 kg (40 lb) = 1 tsp (or tab) (5 mL) Q12H 27 kg (59 lb) = 1^1/2 tsp (or tab) (7.5 mL) Q12H 35 kg (77 lb) = 2 tsp (or tabs) (10 mL) Q12H >40 kg = Use adult dose (max 875 mg Q12H ) Q8H using 125 mg/5 mL susp or 125-mg chewable tablet @ 40 mg/kg/day 9 kg (21 lb) = 1 tsp (or tabs) (5 mL) Q8H 14 kg (31 lb) = 1^1/2 tsp (or tab) (7.5 mL) Q8H 19 kg (42 lb) = 2 tsp (or tabs) (10 mL) Q8H Q8H using 250 mg/5 mL susp or 250-mg chewable tablet @ 40 mg/kg/day 19 kg (42 lb) = 1 tsp (or tabs) (5 mL) Q8H 28 kg (62 lb) = 1^1/2 tsp (or tab) (7.5 mL) Q8H 37 kg (81 lb) = 2 tsp (or tabs) (10 mL) Q8H	Food: Advise taking with food. May administer with or without meals, however GI intolerance and diarrhea may be reduced if taken with meals. Side effects: Diarrhea (common), nausea, vomiting, rash, agitation, seizures, bleeding abnormalities, decreased WBC count, drug fever, superinfection. Caution: May cause nonallergic maculopapular rash, especially in patients with viral infection, mononucleosis, or acute lymphocytic leukemia. Use with caution in hepatic disease. Reduce dose in renal disease: CrCl 10-30 mL/min use a Q8H formulation Q12H CrCl <10 mL/min use a Q8H formulation Q24H
Clindamycin* (Cleocin^®) Generics available Pregnancy: B; Lactation: Unk	Children mild to moderate: 10-15 mg/kg/day (max 1.8 g/day) PO in divided doses 3 or 4 times daily for 7 days.	Food: May take with or without meals. Take with full glass of water to prevent esophagitis.

Caps: 75 mg, 150 mg, 300 mg Oral Solution: 75 mg/5 mL

Severe: 16-30 mg/kg/day (max 1.8 g/day) in divided doses 3 or 4 times daily for 10-14 days. 75 mg/5 mL @ 10 mg/kg/day divided Q8H. 10 kg (22 lb) = ^1/2 tsp (2.5 mL) Q8H 20 kg (44 lb) = 1 tsp (5 mL) Q8H 30 kg (66 lb) = 1^1/2 tsp (7.5 mL) Q8H 40 kg (88 lb) = 2 tsp (10 mL) Q8H >40 kg = Use adult dose. Adult mild to moderate: 150-300 mg PO 3 or 4 times daily for 7 days. Severe: 450 mg PO 4 times daily for 7 days.

Important side effects: Diarrhea—may be severe. Nausea. May cause severe colitis. Encourage patient to report severe, persistent, or bloody diarrhea.

Section contributor: Jill Shelton Wagers, DMD, Boise, ID