Dentists in the UK have a statutory duty to reduce the risk of antimicrobial resistance by ensuring appropriate use of antibiotics, and Antimicrobial Prescribing for General Dental Practitioners gives clear, simple and practical advice on when to prescribe, what to prescribe, for how long and at what dosage. An invaluable asset in any dentist’s library, it covers prescribing to both adults and children in primary dental care, and is available:
The current second edition was published in May 2012 and updated in June 2016 to take account of changed advice on dosages for metronidazole and amoxicillin. For owners of the 2012 edition, the updates are detailed below.
FGDP(UK) has also co-produced a number of related free resources for dentists on antimicrobial stewardship, which you can find on our antimicrobial prescribing page.
Updates to the 2012 edition (NB these updates are incorporated in the print copies currently for sale)
June 2016 (metronidazole dosing)
Metronidazole 400mg three times daily for up to five days, review after 2-3 days and discontinue if resolved5
• 1-3 years: 100mg three times daily for up to five days, review after 2-3 days and discontinue if resolved
• 3-7 years: 200mg twice daily for up to five days, review after 2-3 days and discontinue if resolved
• 7-10 years: 200mg three times daily for up to five days, review after 2-3 days and discontinue if resolved
• Over 10 years: 400mg three times daily for up to five days, review after 2-3 days and discontinue if resolved
Available on prescription as:
• Metronidazole tablets 200mg
• Metronidazole oral suspension 200mg/5m
April 2014 (amoxicillin dosage)
In light of the Health Protection Agency’s guidance: “Management of infection guidance for primary care for consultation & local adaptation” and expert advice relating to issues with resistance to amoxicillin, the BNF has recommended an increased dose of amoxicillin for the management of infections in adults.
Where antimicrobials are indicated for dental infections the dose for amoxicillin is as follows:
500 mg every 8 hours, dose doubled in severe infection
• 1 month–1 year, 125 mg every 8 hours, increased if necessary up to 30 mg/kg every 8 hours;
• 1–5 years, 250 mg every 8 hours, increased if necessary up to 30 mg/kg every 8 hours;
• 5–12 years, 500 mg every 8 hours, increased if necessary up to 30 mg/kg (max. 1 g) every 8 hours
• 12–18 years, 500 mg every 8 hours, in severe infection 1 g every 8 hours
There has also been a change to the dosing for miconazole gel for oral candidosis.
BNF 66 now states:
Dose: prevention and treatment of oral candidiasis, by mouth, adult and child over 2 years, 2.5 mL 4 times daily after meals, retain near oral lesions before swallowing (dental prostheses should be removed at night and brushed with gel); child under 2 years see BNF for Children
Prevention and treatment of intestinal candidiasis, by mouth, adult and child over 4 months, 5 mg/kg 4 times daily; max. 250 mg (10 mL) 4 times daily
Note; Treatment should be continued for at least 7 days after lesions have healed or symptoms have cleared.