From the Research
The best initial treatment for bacterial parotiditis is empiric antibiotic therapy with coverage against Staphylococcus aureus and other oral flora. A recommended regimen is amoxicillin-clavulanate 875/125 mg orally twice daily for 7-10 days. For patients with penicillin allergy, clindamycin 300-450 mg orally four times daily is an appropriate alternative. In severe cases requiring hospitalization, intravenous antibiotics such as ampicillin-sulbactam 3 g every 6 hours or clindamycin 600-900 mg every 8 hours should be administered. Supportive measures should accompany antibiotic therapy, including:
- Adequate hydration
- Warm compresses to the affected area
- Parotid gland massage
- Analgesics for pain control Sialogogues like lemon drops or sour candy can stimulate saliva flow and help clear the ductal system. Treatment should be initiated promptly to prevent complications such as abscess formation or sepsis. The rationale for this approach is that bacterial parotiditis typically results from retrograde infection of the parotid gland through Stenson's duct, with S. aureus being the most common pathogen, though other oral bacteria may be involved, particularly in elderly or immunocompromised patients 1, 2.
Note that the most recent and highest quality study provided is from 2015 3, but it is focused on the treatment of severe infections caused by meticillin resistant Staphylococcus aureus, which may not be directly applicable to the treatment of bacterial parotiditis. However, the study from 2003 1 provides more relevant information on the microbiology and management of acute bacterial suppurative parotitis, and is therefore used as the basis for the recommended treatment regimen.
It is also worth noting that the other studies provided 4, 5 do not provide significant new information that would change the recommended treatment regimen. The study from 2014 5 is focused on the treatment of impetigo, which is a different condition from bacterial parotiditis. The study from 2003 4 is focused on the management of chronic parotitis, which is also a different condition from bacterial parotiditis.
Therefore, the recommended treatment regimen is based on the study from 2003 1, which provides the most relevant information on the microbiology and management of acute bacterial suppurative parotitis.