Local measures are to be used in the first instance:
- Antibiotics should only be used if there is evidence of spreading infection, systemic involvement, the person is immunocompromised or has uncontrolled diabetes.
Local Measures
- Scaling, irrigation and oral hygiene advice.
- Limited debridement/scaling may be tolerated in the acute phase due to pain.
- Consider analgesia.
- Consider the use of 0.2% chlorhexidine mouthwash until acute symptoms are relieved. Caution: very rare risk of anaphylaxis with chlorhexidine.
Comments from the Expert Advisory Group
- Necrotising Periodontal Disease is very rare in children under 12 years of age (in the absence of immunosuppression or malnutrition). Consideration should be given to an alternative diagnosis in this age cohort.
Treatment
If antibiotics deemed clinically indicated:
| NECROTISING PERIODONTAL DISEASE ANTIBIOTIC TREATMENT TABLE | |||
| Drug | Dose | Duration | Notes |
| 1st choice options | |||
|
Metronidazole
|
1-2 years: 50mg every 8 hours 3-6 years: 100mg every 12 hours 7-9 years: 100mg every 8 hours 10-17 years: 200mg every 8 hours. For children with severe infection (or at extremes of body weight for their age) consider 7.5mg/kg (max. 400mg) every 8 hours Adults: 400mg every 8 hours |
3 days (5 days in severe infection or if adequate source control not achieved)
|
Advise patients to avoid alcohol. Anticoagulant effect of warfarin may be enhanced by Metronidazole. Liquid preparation available: 200mg/5ml
|
| 2nd choice options / If metronidazole contraindicated | |||
|
Amoxicillin
|
1-11 months: 125mg every 8 hours 1-4 years: 250mg every 8 hours 5-11 years: 500mg every 8 hours For children with severe infection (or at extremes of body weight for their age) consider 30mg/kg (max. 1g) every 8 hours Adults and children ≥ 12 years: |
3 days (5 days in severe infection or if adequate source control not achieved)
|
Avoid in penicillin allergy. Liquid preparation available as: 125mg/5ml 250mg/5ml
|
Weight Based Dosing Tables for Analgesics in Children
Patient Information
Safe Prescribing (visit the safe prescribing page)
- Doses are oral and for adults unless otherwise stated
- Dosing in children quick reference dosage/weight guide
- Penicillin allergy – tips on prescribing in penicillin allergy
- Renal impairment dosing table
- Safety in Pregnancy and Lactation
- 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 November 2023