From the FDA Drug Label
- 5 Geriatric Use Of the 3,119 patients in an analysis of clinical studies of amoxicillin and clavulanate potassium, 32% were ≥65 years old, and 14% were ≥75 years old No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out
The first-line antibiotic treatment for a 71-year-old male with a salivary gland infection is amoxicillin-clavulanate (PO) 1, 1.
- Key considerations:
- No overall differences in safety or effectiveness were observed between elderly subjects and younger subjects.
- Greater sensitivity of some older individuals cannot be ruled out.
- This drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function.
- Care should be taken in dose selection, and it may be useful to monitor renal function.
From the Research
The first-line antibiotic treatment for a 71-year-old male with a salivary gland infection is amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 7-10 days. For patients with penicillin allergies, clindamycin 300-450 mg orally four times daily can be used as an alternative 2. The treatment should be started promptly to prevent complications, especially in older adults who may have a compromised immune system. Adequate hydration is essential during treatment to promote salivary flow and help clear the infection. Warm compresses applied to the affected area can provide symptomatic relief. Amoxicillin-clavulanate is preferred because it provides coverage against the mixed aerobic and anaerobic bacteria commonly involved in salivary gland infections, including Staphylococcus aureus and oral anaerobes. The addition of clavulanic acid helps overcome beta-lactamase resistance.
Some key points to consider when treating salivary gland infections include:
- The most common bacteria involved in salivary gland infections is Staphylococcus aureus 2
- Amoxicillin-clavulanate achieves favorable concentrations in saliva and is effective against the bacteria implicated in sialadenitis 3
- Cephalosporins and fluoroquinolones also display superior pharmacokinetics in saliva, but amoxicillin-clavulanate is generally the first-line treatment due to its broad coverage and safety profile
- If symptoms worsen despite antibiotic therapy or if the patient develops fever, increased swelling, or difficulty swallowing, prompt medical reevaluation is necessary as hospitalization for intravenous antibiotics may be required 4, 5, 6
It's also important to note that salivary gland infections can be caused by a variety of factors, including dehydration, malnutrition, and chronic illness, and that treatment should be tailored to the individual patient's needs and underlying health status 2.