Second line antibiotics
Second line antibiotics
- The use of broad-spectrum antibiotics is associated with the increase in Clostridioides difficile infection observed in both primary and secondary care.
- The empirical use of second line antibiotics offers no advantage over first line antibiotics for most dental patients. Their routine use in dentistry is unnecessary and will contribute to the development of antimicrobial resistance.
- Failure of antibiotic treatment is usually due to inadequate source control and adjunctive or second line antibiotics are unlikely to result in clinical improvement without adequate local measures.
- However, if a patient has completed a full course of the first-line antibiotic prescribed and has not responded to treatment, carry out a review (including patient compliance, the effectiveness of local measures and the diagnosis [see Bacterial infections 3-day review tool]), and either refer the patient or consider speaking to a specialist before prescribing clindamycin or clarithromycin.3
- Use of these drugs should be restricted to second-line treatment of severe infections only.
- Before prescribing antibiotics, refer to the BNF or BNFC for drug interactions.
- Advise patients to space out doses as much as possible throughout the day.
More about Second line antibiotics
The empirical use of other antibiotics such as clindamycin and clarithromycin offers no advantage over amoxicillin, phenoxymethylpenicillin and metronidazole for most dental patients. Their routine use in dentistry is unnecessary and could contribute to the development of antimicrobial resistance. Also the use of broad-spectrum antibiotics is associated with the increase in Clostridioides difficile infection observed in both primary and secondary care.
However, if a patient has completed a full course of the first-line antibiotic prescribed and has not responded to treatment, carry out a review (including patient compliance, the effectiveness of local measures and the diagnosis [see Bacterial infections 3-day review tool]), and either refer the patient or consider speaking to a specialist before prescribing clindamycin or clarithromycin.3
Clindamycin is active against Gram-positive cocci, including streptococci and penicillin-resistant staphylococci, and can be used if the patient has not responded to the first line antibiotic prescribed. However, clindamycin can cause the serious adverse effect of antibiotic-associated colitis more frequently than other antibiotics.
Clarithromycin is active against beta-lactamase-producing bacteria.
As the use of broad-spectrum antibiotics, especially clindamycin, can result in Clostridioides difficile infection, use of these drugs should be restricted to second-line treatment of severe infections only.