From the Research
For infections associated with salivary stones, cephalosporins and fluoroquinolones are recommended as the first-line antibiotic treatment due to their superior pharmacokinetics in saliva and coverage of the spectrum of bacteria implicated in sialadenitis, as shown in a systematic review of the literature 1. The choice of antibiotic is crucial in managing infections associated with salivary stones, and the goal is to provide coverage against the mixed aerobic and anaerobic oral flora commonly involved in these infections.
- Cephalosporins, particularly those administered intravenously, achieve the highest concentrations in saliva, followed by orally administered cephalosporins and fluoroquinolones, which exceed the minimal inhibitory concentrations of the bacteria of interest, including Staphylococcus aureus, Viridans streptococci, and anaerobes 1.
- Phenoxymethylpenicillin and tetracyclines are not secreted in the saliva at bactericidal levels, making them less effective options for treating sialadenitis 1.
- The management of salivary stones is focused on removing the stone and preserving salivary gland function, which depends on the size and location of the stone, and may involve minimally invasive techniques or surgery, in addition to antibiotic therapy 2, 3.
- Patients should complete the full course of antibiotics even if symptoms improve quickly, stay hydrated, and use warm compresses and gentle massage to stimulate saliva flow and potentially help with stone passage.
- Recent trends in the treatment of sialolithiasis have revealed a potential for significant changes in therapeutic strategies, including the use of intraductal shock-wave lithotripsy (ISWL) and modifications of transoral duct surgery (TDS), which may reduce the need for more invasive procedures 3.