Medicines alert: Shortage of Metronidazole oral tablets

The ADA Dental Therapeutic Committee (DTC) wishes to urgently advise ADA members that there is a national shortage of all brands and strengths metronidazole oral tablets, which is anticipated to last at least until the end of August and, for some brands, until November 2022.  
 
Specific details of the shortage are outlined on the TGA website. 

Note that some brands and strengths of metronidazole tablets have also been discontinued. 
 

What to prescribe instead

While metronidazole is unavailable, the ADA DTC directs practitioners to the advice regarding spreading odontogenic infections in Therapeutic Guidelines - Oral and Dental Version 3, regarding recommended alternatives.  This advice is as follows: 

A spreading odontogenic infection that has caused facial swelling but no severe or systemic features can be managed in an outpatient dental setting. Management involves:

- drainage of pus, with culture and susceptibility testing of pus samples

- surgical or dental treatment (endodontic or periodontal treatment, or tooth extraction) to address the source of infection

- oral antibiotic therapy, ideally started after samples are taken for culture.

For antibiotic therapy of spreading odontogenic infections without systemic or severe features, use:

- Amoxicillin/Clavulanic acid 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 5 days. 

For patients hypersensitive to penicillins:

- Clindamycin 300mg (child: 7.5 mg/kg up to 300 mg) orally, 8-hourly for 5 days

Please refer to Therapeutic Guidelines Oral and Dental Version 3 for more detail on managing spreading odontogenic infections.

For further or more tailored advice, you can contact the ADA's PharmaAdvice service on pharma-advice@ada.org.au or 0419 752 528