From the Research
The second-line treatment for parotitis typically involves antibiotics that cover both aerobic and anaerobic organisms, particularly if first-line therapy with amoxicillin-clavulanate has failed or if the patient has a penicillin allergy.
Key Considerations
- Clindamycin (300-450mg orally four times daily for 7-10 days) is commonly used as a second-line agent 1.
- For more severe cases or hospitalized patients, intravenous options include clindamycin (600-900mg every 8 hours) or a combination of a third-generation cephalosporin with metronidazole 2.
- Supportive measures should continue alongside antibiotic therapy, including:
- Adequate hydration
- Warm compresses to the affected area
- Sialagogues (such as lemon drops or sour candy) to stimulate saliva flow
- Pain management with acetaminophen or NSAIDs
Pathogens and Treatment
- The common pathogens in parotitis include Staphylococcus aureus and anaerobic bacteria, which may be present in more complicated infections 1, 2.
- If the patient doesn't respond to second-line therapy, further investigation with imaging and possibly drainage of any abscess formation may be necessary 3.
Surgical Treatment
- In cases of chronic parotitis, parotidectomy can be indicated when conservative measures and sialendoscopy fail 4.
- Near-total parotidectomy and superficial parotidectomy are both effective treatments, with no evident difference between them regarding efficiency, facial nerve palsy, or Frey syndrome 4.