Antibiotics revisited.

The choice of an antibiotic for the management of an acute dental infection should be made from a relatively small range of agents. There is little evidence for prescribing the newer, more expensive, wide-spectrum, antibiotics. Failure to respond to therapy is usually due to inadequacy of dose, or failure to eliminate aggravating factors. The temptation to use antibiotics for the management of trivial infections should be resisted, and such problems managed by careful attention to first principles. The prophylactic use of antibiotics is less clear cut. Guidelines have been produced by expert committees that cover some situations, but such guidelines cannot be all-embracing. By weighing individual factors, the dentist should be able to reach a decision as to when antibiotic cover is indicated. This can only be done by maintaining contact with the literature in order to note changing recommendations, and drawing conclusions from conflicting opinions.