A randomised trial of co-amoxiclav (Augmentin) versus penicillin V in the treatment of acute dentoalveolar abscess

In a randomised, operator-blind, comparative clinical trial, the efficacy of co-amoxiclav (250 mg amoxycillin plus 125 mg clavulanic acid, eight-hourly) was compared to that of penicillin V (250 mg phenoxymethylpenicillin, six-hourly) in the treatment of acute dentoalveolar abscess. In each case surgical drainage was established at the time of initial presentation by incision of any soft tissue swelling, accompanied by either extraction of the tooth or extirpation of the pulp as indicated clinically. Each patient recorded the severity of their pain and swelling at eight-hourly intervals using graduated scales. Clinical review was performed after 1, 2 and 5 days of treatment, at which time sublingual temperature was recorded and the presence of cervical lymphadenopathy determined. A total of 79 patients were clinically assessable on Day 5 (co-amoxiclav, n = 41; penicillin V, n = 38). The two groups were comparable for sex, age, presenting features and microbiology. Penicillin-resistant organisms were isolated from five patients (co-amoxiclav, n = 3; penicillin V, n = 2). Symptoms improved in all patients following the start of treatment, however those receiving co-amoxiclav recorded a significantly greater decrease in pain during the second (P = 0.026) and third days (P = 0.025). Only one patient reported a significant adverse effect associated with drug therapy, and this was in the penicillin group. Co-amoxiclav was as effective as penicillin therapy