From the Guidelines
Parotitis should be treated supportively, as indicated by the most recent evidence 1. The treatment approach for parotitis depends on the underlying cause, which can be either viral or bacterial.
- Viral parotitis, such as mumps, typically requires supportive care, including hydration, pain relief with acetaminophen or ibuprofen, and warm compresses.
- Bacterial parotitis, on the other hand, necessitates antibiotic therapy, usually with amoxicillin-clavulanate or clindamycin in cases of penicillin allergy. Key aspects of management include staying well-hydrated, practicing good oral hygiene, and stimulating saliva production with sugar-free candies or gum to help manage symptoms and prevent complications. According to the evidence 1, diagnosis of parotitis can be made through clinical presentation, and in some cases, through PCR of saliva or serology, highlighting the importance of a thorough diagnostic approach. It is essential to note that severe cases with abscess formation may require surgical drainage, underscoring the need for close monitoring and timely intervention when necessary. The evidence 1 emphasizes a supportive treatment approach for parotitis, which is crucial in managing the condition effectively and preventing potential complications.
From the Research
Causes of Parotitis
- 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 recognized as an important cause of this infection 3, 2
- Chronic parotitis is a nonspecific sialadenitis that often is seen first in the dental office, with a cause that is most likely multifactorial and includes decreased salivation, stasis and an ascending retrograde duct infection 4
Management and Treatment
- Therapy includes maintenance of hydration and administration of parenteral antimicrobial therapy 3
- Once an abscess has formed, surgical drainage is required 3, 2
- The choice of antimicrobial depends on the etiologic agent 3
- Early and proper antimicrobial therapy may prevent suppuration 2
- Initial empiric therapy that is directed against both aerobic and anaerobic bacteria may be required until a specific causal diagnosis is available 2
- Treatment for chronic parotitis is palliative in nature 4
Predisposing Factors
- Dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation are predisposing factors to suppurative infections 2
- Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis 3