Antibiotics and dentist

Question

I have CF and use cotrimoxazol as maintenance therapy. I needed a tooth extraction. The dentist wanted to give antibiotics but because I already take antibiotics he didn’t find that necessary. Does cotrimoxazol help when you need a tooth extraction? You cannot take two antibiotics at the same time, can you ?

Answer

Dear ECORN-user,

We cannot give general advice here. Your treating CF-doctor has all the elements to decide about your therapy. We can just give some general information.
When patients have a tooth abscess, the most important treatment is to take care of the tooth (possibly extract it) and open the abscess so that the pus can come out. Antibiotics are only given in case of serious infection of the surrounding area or prior to treatment of the tooth.
Mainly the bacteria normally present in the mouth are involved in tooth abscesses. These are mainly anaerobic bacteria that thrive well in an oxygen poor environment like an abscess, peptostreptococci, streptococci and gram-negative bacteria. When an antibiotic is given to treat a tooth abscess, it is important that the bacteria are sensitive to the antibiotic chosen. Cotrimoxazole is an antibiotic with a relatively large spectrum (that is ‘many bacteria are sensitive to it’). In people with CF it is regularly used to treat specific infections (for instance Stenotrophomonas maltophilia) or as maintenance treatment of chronic infection. It however does not have a good activity against anaerobic bacteria and is thus not an obvious choice for the treatment of a tooth abscess. To treat a tooth abscess an antibiotic like amoxicillin, amoxicillin-clavulanic acid (or in case of allergy to these antibiotics clindamycin) is appropriate. This antibiotic can –if needed- be temporarily added to the treatment with cotrimoxazol. To answer the last part of your question: taking two antibiotics at the same time is not unusual and is even a strategy to treat some infections more efficiently.

Kind regards
Dr. M. Boon

01.12.2011