Role of Steroids in Treating Parotitis in Adults
Short courses of oral corticosteroids can be effective for treating acute parotitis in adults, with prednisolone at 0.5-1 mg/kg/day showing dramatic response in reducing inflammation and symptoms.
Clinical Presentation and Diagnosis
Parotitis presents with:
- Swelling of the parotid gland(s)
- Pain in the affected area
- Potential fever
- Recurrent episodes in chronic cases
- Possible difficulty eating or opening mouth
Treatment Approach
First-line Treatment
- NSAIDs/COXIBs: Start with maximum tolerated and approved dosage for pain and inflammation control 1
- Hydration: Encourage increased fluid intake
- Warm compresses: Apply to affected area
Role of Corticosteroids
When to Consider Steroids
- Moderate to severe symptoms not responding to NSAIDs
- Significant swelling causing functional impairment
- Recurrent episodes of idiopathic parotitis
Recommended Steroid Regimen
- Oral prednisolone: 0.5-1 mg/kg/day (typically 30-60 mg for adults) 2
- Duration: Short course of 5-7 days with tapering
- Administration: Divided doses initially, then single morning dose
The most recent evidence from a 2024 study showed dramatic response to short-course prednisolone (0.5 mg/kg) administered on the first day of parotitis episodes 2. This approach demonstrated significant improvement compared to the natural course of the disease.
Important Considerations
- Avoid long-term steroid use: Guidelines consistently recommend avoiding prolonged corticosteroid therapy due to potential adverse effects 1
- Concurrent antibiotics: May be necessary if bacterial infection is suspected
- Monitoring: Watch for:
- Resolution of swelling and pain
- Potential side effects of steroids (even with short courses)
- Return of normal salivary function
Evidence for Steroid Efficacy
Research has demonstrated that during acute parotitis exacerbations, salivary electrolytes show significant abnormalities (elevated sodium, chloride, and glucose; decreased potassium and phosphate) that normalize during recovery following corticosteroid treatment 3.
Cautions and Contraindications
Side effects: Even short courses can cause:
- Mild gastrointestinal complaints (nausea, gastric discomfort)
- Potential mood disturbances
- Temporary glycemic changes
Contraindications:
- Active untreated infection (particularly fungal)
- Uncontrolled diabetes
- History of adverse reactions to steroids
Follow-up
- Assess response within 2-4 days of initiating treatment
- If symptoms persist beyond 7 days despite treatment, consider:
- Alternative diagnoses
- Imaging studies (ultrasound, CT)
- Referral to otolaryngology
While the evidence specifically for parotitis is limited, the approach is supported by evidence from related conditions where short-course steroids have shown benefit for inflammatory conditions affecting salivary and related structures.