MRONJ (medication related osteonecrosis of the jaw)

Indication for antimicrobials: Exposed/necrotic bone associated with infection as evidenced by pain and erythema in the region of the exposed bone with or without purulent drainage.

Recommended antibiotic therapy listed below is empiric. Treatment should always be tailored to culture and sensitivity.
All patients with suspected MRONJ should be referred to Maxfax

Treat infective flares for 7-10 days

Open all

amoxicillin 500mg po tds (iv if NBM)

For severe cases: ADD metronidazole 400mg po tds (or 500mg iv tds if NBM)

For penicillin allergy (non-severe or severe)

doxycycline 100mg po bd

For severe cases: ADD metronidazole 400mg po tds (or 500mg iv tds if NBM)

See Faculty of Dental Surgery Antimicrobial Prescribing in Dentistry Good Practice Guidelines and American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws

Preferred

Alternative

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