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Nearly 20% of patients treated for dental infections in urgent care, emergency departments, and primary care settings are being prescribed clindamycin — an antibiotic with a decades-old FDA black box warning — despite safer alternatives being available. The ADA has recommended penicillin-class antibiotics since 2019, yet overprescribing persists, partly driven by overestimated penicillin allergies. Clindamycin also showed the highest treatment failure rate at 11%, six times higher than alternatives.
Nearly 1 in 5 patients seeking care for dental infections outside of a dentist's office is being prescribed clindamycin — a high-risk antibiotic linked to life-threatening Clostridioides difficile (C. diff) infections — despite the American Dental Association (ADA) recommending safer penicillin-class alternatives since 2019. A new study published in Open Forum Infectious Diseases, covering more than 12,000 patients across Michigan, found that while 75% received the recommended penicillin-class antibiotics, nearly 20% were still given clindamycin.
A key driver of inappropriate prescribing is overestimated penicillin allergies. Though 10% of Americans have a penicillin allergy on their chart, fewer than 1% are truly allergic. In the study, 21% of patients who received a non-penicillin antibiotic had no documented allergy at all, and 27% had only a mild intolerance. Clinicians can use a simple four-question screening tool to quickly assess true allergy risk before defaulting to clindamycin.
By the Numbers:
Why it matters: Dental infections are among the most common reasons people visit emergency departments, yet the antibiotics prescribed are often riskier and less effective than recommended alternatives. Improving prescribing habits — and addressing penicillin allergy misconceptions — could prevent serious harm and reduce antibiotic resistance.
