From the Guidelines
Parotiditis should be managed supportively, as indicated by the most recent evidence 1, focusing on symptom relief and hydration, with specific treatments depending on the underlying cause, such as viral or bacterial infection.
Diagnosis and Treatment Approaches
- For viral parotiditis, such as that caused by the mumps virus, treatment is primarily supportive, aiming to alleviate symptoms and prevent complications.
- The diagnosis of viral causes like mumps can be approached through clinical presentation and, when necessary, confirmed by tests such as the heterophile antibody test or IgM antibodies versus viral capsid antigen for Epstein-Barr virus, as mentioned in 1.
- Bacterial parotiditis, on the other hand, requires antibiotic therapy, with considerations for the most likely pathogens, including Staphylococcus aureus.
Management Strategies
- Supportive care includes rest, adequate hydration, and pain management using over-the-counter medications like acetaminophen or ibuprofen.
- Warm or cold compresses can be applied to the affected area to reduce discomfort.
- For bacterial infections, antibiotics such as amoxicillin-clavulanate or clindamycin for penicillin-allergic patients are considered, based on the severity of the infection and patient-specific factors.
Prevention
- Vaccination against mumps, as part of the MMR vaccine, is a crucial preventive measure for viral parotiditis.
- Maintaining good oral hygiene and ensuring adequate hydration are important for preventing bacterial parotiditis, particularly in vulnerable populations.
Considerations
- The approach to parotiditis must consider the potential for complications, such as abscess formation, which may necessitate more invasive interventions like surgical drainage.
- Given the information in 1, the focus on supportive care for parotiditis, especially when caused by viral infections, underscores the importance of monitoring and managing symptoms to prevent severe outcomes.
From the Research
Causes of Parotiditis
- Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses 2
- Acute suppurative parotitis is generally caused by Staphylococcus aureus, Streptococcus species, and rarely, gram-negative bacteria 2
- Anaerobic bacteria, mostly Peptostreptococcus species and Bacteroides species, and pigmented Porphyromonas species and Prevotella species have been recently recognized as an important cause of this infection 2
- Drug-induced parotitis has been associated with medications such as l-asparaginase, clozapine, and phenylbutazone 3
Diagnosis and Management
- Assessment of the disease process should differentiate local primary parotid infection from systemic infection when this gland is also involved as part of a generalized inflammatory condition 2
- Sialography remains the investigation of choice for chronic parotitis 4
- Diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice 4
- Management options for chronic parotitis are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention 4
- Early and proper antimicrobial therapy may prevent suppuration in acute suppurative parotitis 2
- Surgical drainage may be indicated when pus has formed in parotid abscess 2, 5
Predisposing Factors and Complications
- Predisposing factors to suppurative infections include dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation 2
- Diabetes mellitus is a significant comorbid factor in parotid abscess 5
- Complications of parotid abscess include facial nerve palsy and overwhelming septicaemia 5