Dawaa Reference

infectious

Acute dental abscess (odontogenic infection)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian National Drug Formulary - Antimicrobial 2023 · SDCEP Dental Prescribing 2020

Verified against3 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023
  • SDCEP Dental Prescribing 2020
  • Acute dental abscess (odontogenic infection) - disease-level clinical article (dental-abscess-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Swelling inside the mouth, sometimes painless, is what patients most often report first
  • Pain worsened by biting, with the tooth feeling loose from loss of periodontal support
  • A sense that the tooth is sitting higher than usual is a common complaint
  • Pus discharges mainly with pressure or probing, and patients notice a bad taste from it [pus]
  • A history of recent periodontal debridement or antimicrobial use is relevant to how the abscess formed [abscess]
  • Known or unrecognized diabetes raises the risk of this type of abscess and should be asked about directly [abscess]
  • An acute abscess brings pain, tenderness, and visible pus, while a chronic one shows a sinus tract with little or no pain [abscess · pus]

Signs — what you find (4)

  • Deep probing depths over 6 mm, suppuration, loose teeth, and furcation involvement are typical periodontal signs [pus]
  • Tenderness is elicited on palpation and on tapping the tooth from the side
  • An oval swelling of the gum over the side of the root may be visible, though deeper abscesses are easy to miss
  • Pulp testing with electric or heat and cold stimulation still comes back normal, pointing away from a nerve-origin cause

Tests (5)

  • A periapical x-ray typically shows widened ligament space and horizontal or vertical bone loss
  • A dark area at the root tip on x-ray points instead to an abscess of nerve origin, alone or combined with the periodontal one
  • Tracing a gutta-percha point along the draining tract and x-raying where it stops helps locate the source of infection
  • Darkfield microscopy of the pus can help rule out a nerve-origin abscess based on the different microbial mix
  • PET scanning is highly accurate at picking up periodontal and other anaerobic abscesses in the mouth

If not this — what else fits (7)

  • A periapical (nerve-origin) abscess is suggested by trauma, worn or fractured teeth, deep decay, or a deep filling, with a negative or unclear pulp vitality test
  • In a combined perio-endo lesion, a positive pulp test points to a periodontal origin while a non-response points to a nerve origin
  • A pericoronal abscess around a partly erupted tooth can mimic this, but neighboring teeth stay vital with no extra pocketing
  • A partial root fracture shows increased mobility and tenderness, best confirmed with x-rays taken from several angles
  • A gingival squamous cell carcinoma can mimic a recurring periodontal abscess and should be considered in resistant cases
  • Self-inflicted gum injury from habits like nail-biting or poking with a pen or pin can look similar and is excluded by a full history
  • Less common look-alikes include a lateral periapical cyst, postoperative infection, odontogenic tumors, metastatic carcinoma, lymphoma, pyogenic granuloma, and osteomyelitis

SourceStatPearls "Periodontal Abscess" - disease-level clinical article

Presentation findings are traced to the source above.

1

AMOXICILLIN + CLAVULANIC ACID

1st line

Strength1000 mg

Formoral.solid

Adult dose and duration

1 g (875/125 mg) orally twice daily x 5 days

Paediatric dose

25-45 mg/kg/day [child max 1750 mg]

(Dosed as amoxicillin component in 2 divided doses daily)

Dose by weight
3kg75-135 mg/day
4kg100-180 mg/day
5kg125-225 mg/day
6kg150-270 mg/day
7kg175-315 mg/day
8kg200-360 mg/day
9kg225-405 mg/day
10kg250-450 mg/day
11kg275-495 mg/day
12kg300-540 mg/day
13kg325-585 mg/day
14kg350-630 mg/day
15kg375-675 mg/day
16kg400-720 mg/day
17kg425-765 mg/day
18kg450-810 mg/day
19kg475-855 mg/day
20kg500-900 mg/day
21kg525-945 mg/day
22kg550-990 mg/day
23kg575-1035 mg/day
24kg600-1080 mg/day
25kg625-1125 mg/day
26kg650-1170 mg/day
27kg675-1215 mg/day
28kg700-1260 mg/day
29kg725-1305 mg/day
30kg750-1350 mg/day
31kg775-1395 mg/day
32kg800-1440 mg/day
33kg825-1485 mg/day
34kg850-1530 mg/day
35kg875-1575 mg/day
36kg900-1620 mg/day
37kg925-1665 mg/day
38kg950-1710 mg/day
39kg975-1750 mg/day (upper capped)
40kg1000-1750 mg/day (upper capped)
41kg1025-1750 mg/day (upper capped)
42kg1050-1750 mg/day (upper capped)
43kg1075-1750 mg/day (upper capped)
44kg1100-1750 mg/day (upper capped)
45kg1125-1750 mg/day (upper capped)
46kg1150-1750 mg/day (upper capped)
47kg1175-1750 mg/day (upper capped)
48kg1200-1750 mg/day (upper capped)
49kg1225-1750 mg/day (upper capped)
50kg1250-1750 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Beta-lactam combined with a beta-lactamase inhibitor for odontogenic infection, covering the mixed oral aerobic and anaerobic flora typically responsible; used alongside urgent dental drainage or extraction, since antibiotics alone do not resolve a dental abscess and are not a substitute for source control.

Cautions
  • Antibiotics are adjuncts to dental intervention (drainage/extraction); refer urgently to dentist.
  • Contraindicated in penicillin hypersensitivity.
  • Take with meals to reduce GI adverse effects.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.EIPICO14.00 EGP (1.40/unit)
JULMENTIN 2X 1GM 15 TAB.JULPHAR57.50 EGP (3.83/unit)
DEXICLAVE 1 GM 10 F.C. TABS.RAMEDA > NOVELL PHARMA38.50 EGP (3.85/unit)
MACLAVEX 1 GM 14 F.C.TABS.MASH PREMIERE105.00 EGP (7.50/unit)
CLAVIMOX 1 GM 12 F.C.TABS.PHARCO130.00 EGP (10.83/unit)
MEGAMOX 1 GM 14 F.C. TABS.AL JAZEERA PHARMACEUTICAL > HIKMA PHARMA178.00 EGP (12.71/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETSGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Acute dental abscess (odontogenic infection) - disease-level clinical article (dental-abscess-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Systemic spread of infection can progress to extra-oral head/neck swellings, lymphadenopathy, or sepsis.
3

METRONIDAZOLE

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg orally three times daily x 5 days

Paediatric dose

22.5 mg/kg/day [child max 1500 mg]

(7.5 mg/kg per dose 3 times daily (22.5 mg/kg/day))

Dose by weight
3kg67.5 mg/day
4kg90 mg/day
5kg112.5 mg/day
6kg135 mg/day
7kg157.5 mg/day
8kg180 mg/day
9kg202.5 mg/day
10kg225 mg/day
11kg247.5 mg/day
12kg270 mg/day
13kg292.5 mg/day
14kg315 mg/day
15kg337.5 mg/day
16kg360 mg/day
17kg382.5 mg/day
18kg405 mg/day
19kg427.5 mg/day
20kg450 mg/day
21kg472.5 mg/day
22kg495 mg/day
23kg517.5 mg/day
24kg540 mg/day
25kg562.5 mg/day
26kg585 mg/day
27kg607.5 mg/day
28kg630 mg/day
29kg652.5 mg/day
30kg675 mg/day
31kg697.5 mg/day
32kg720 mg/day
33kg742.5 mg/day
34kg765 mg/day
35kg787.5 mg/day
36kg810 mg/day
37kg832.5 mg/day
38kg855 mg/day
39kg877.5 mg/day
40kg900 mg/day
41kg922.5 mg/day
42kg945 mg/day
43kg967.5 mg/day
44kg990 mg/day
45kg1012.5 mg/day
46kg1035 mg/day
47kg1057.5 mg/day
48kg1080 mg/day
49kg1102.5 mg/day
50kg1125 mg/day
Choice

Alternatives, both for the penicillin-allergic patient. Metronidazole is stated as a first-line option in penicillin allergy, attributed to SDCEP Dental Prescribing 2020; clindamycin is the alternative when metronidazole is unsuitable, and it carries a higher Clostridioides difficile risk.

Dose source

SDCEP Dental Prescribing 2020

Why

Antibiotic targeting the anaerobic bacteria implicated in odontogenic infection; used first-line for patients with penicillin allergy in acute dental abscess.

Cautions
  • May cause metallic taste and nausea.
  • Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023.
  • Metronidazole is a first-line option for patients with penicillin allergy.
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP
4

CLINDAMYCIN

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg orally every 6 hours x 5 days

Paediatric dose

8-20 mg/kg/day (8 to 20 mg/kg/day divided every 6 to 8 hours.)

Dose by weight
3kg24-60 mg/day
4kg32-80 mg/day
5kg40-100 mg/day
6kg48-120 mg/day
7kg56-140 mg/day
8kg64-160 mg/day
9kg72-180 mg/day
10kg80-200 mg/day
11kg88-220 mg/day
12kg96-240 mg/day
13kg104-260 mg/day
14kg112-280 mg/day
15kg120-300 mg/day
16kg128-320 mg/day
17kg136-340 mg/day
18kg144-360 mg/day
19kg152-380 mg/day
20kg160-400 mg/day
21kg168-420 mg/day
22kg176-440 mg/day
23kg184-460 mg/day
24kg192-480 mg/day
25kg200-500 mg/day
26kg208-520 mg/day
27kg216-540 mg/day
28kg224-560 mg/day
29kg232-580 mg/day
30kg240-600 mg/day
31kg248-620 mg/day
32kg256-640 mg/day
33kg264-660 mg/day
34kg272-680 mg/day
35kg280-700 mg/day
36kg288-720 mg/day
37kg296-740 mg/day
38kg304-760 mg/day
39kg312-780 mg/day
40kg320-800 mg/day
41kg328-820 mg/day
42kg336-840 mg/day
43kg344-860 mg/day
44kg352-880 mg/day
45kg360-900 mg/day
46kg368-920 mg/day
47kg376-940 mg/day
48kg384-960 mg/day
49kg392-980 mg/day
50kg400-1000 mg/day
Dose source

Periodontal Abscess - StatPearls - NCBI Bookshelf (NBK560625) for the indication - verbatim: "Clindamycin is recommended as an alternative for patients with penicillin allergies." Dose from Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) - verbatim: "Oral: 150–300 mg every 6 hours." Paediatric dose from the same monograph, the oral capsule line - verbatim: "Oral: Infants, Children, and Adolescents: Hydrochloride salt (capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours." Neither source states a course length for odontogenic infection; 5 days matches the co-amoxiclav and metronidazole courses already sourced for acute dental abscess.

Why

The alternative when penicillin is not an option. It penetrates bone and covers the oral anaerobes that drive odontogenic infection.

Cautions
  • Antibiotics are an adjunct, not the treatment. The abscess still needs drainage or dental treatment; a course of clindamycin alone will not resolve it.
  • Warn about diarrhoea. Clindamycin carries the highest Clostridioides difficile risk of the oral antibiotics here - stop it and reassess if diarrhoea develops during or after the course.
  • Take with a full glass of water to avoid oesophageal irritation.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.