Section 4 - Management options for primary caries / 4.4 Article: Pain relief & antibiotics in children

There are various post-operative medication options for managing pain and infection.

Pain Relief

For mild to moderate odontgenic or post-operative pain, an appropriate 5-day regimen is paracetamol. If the pain is also inflammatory, see the ibuprofen table below.

Paracetamol and Ibuprofen are recommended for pain relief in children. Aspirin should be avoided in patients under 16 due to risk of Reye’s syndrome. Avoid NSAIDs in children with asthma, known allergy, peptic ulcer disease, those on oral anticoagulants or those who have an inherited bleeding disorder. Use NSAIDs with caution in patients with renal, cardiac or hepatic impairment.

Pain relief should be prescribed only as a temporary measure. Ensure that the underlying cause of the pain is managed.

If the following regime is ineffective refer the patient to the general medical practitioner.


Indications: Systemic signs of infection (<36OC and >38OC), spreading infection, unable to achieve drainage.

First-line antibiotics regimens are for 5 days.

In cases of severe infection for:

Children up to age 11: Can increase dose of amoxicillin to 30mg/kg (max 1g) TDS and dose of metronidazole to 7.5mg/kg (max 400mg) TDS

Children age 12 - 17: Can double dose of amoxicillin and metronidazole

• Can use metronidazole as an alternative in penicillin allergic patients or as an adjunct in severe infections.

Second-line antibiotics regimens are for 7 days.

To be prescribed only if the patient does not respond to first line antibiotics. Consider referring or speaking to a specialist before prescribing.