Antibiotic resistance in odontogenic infections: A systematic review of current evidence and implications for guideline-based therapy
Abstract
OBJECTIVES: This review aims to summarize and evaluate the current evidence on antibiotic resistance in odontogenic infections, with a special focus on empirical therapy, resistance patterns, and guideline-based recommendations. The update of the German S3 guideline “Odontogenic Infections” provides the clinical and methodological framework for this review. MATERIALS AND METHODS: A systematic literature search was performed to identify studies published between 2016 and 2025 on antibiotic resistance in odontogenic infections. Both retrospective and prospective studies were included. Special attention was given to resistance rates of commonly used antibiotics and the differentiation of therapy in patients with suspected penicillin allergy. The selected studies were integrated into the German guideline development process to ensure relevance and consistency with current clinical practices. RESULTS: The review confirms increasing resistance rates for Penicillin G/V and aminopenicillins, particularly against Staphylococcus spp. In contrast, the combination of an aminopenicillin with a beta-lactamase inhibitor remains effective in most cases. Clindamycin shows notable resistance and is associated with higher rates of adverse effects. Recent studies suggest that certain cephalosporins, such as cefazolin, may be safe alternatives for patients with non-confirmed penicillin allergies. Clinical strategies such as PEN-FAST scoring and de-labeling are gaining increasing importance in…
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