What is the treatment for parotitis?

Treatment of Parotitis

The treatment of bacterial suppurative parotitis requires adequate hydration, parenteral antimicrobial therapy targeting Staphylococcus aureus and anaerobic bacteria, and surgical drainage if an abscess has formed. 1

Types of Parotitis and Initial Assessment

Parotitis can be classified into:

• Acute bacterial suppurative parotitis
• Chronic recurrent parotitis (juvenile and adult forms)

Key Clinical Findings to Assess:

• Unilateral or bilateral swelling
• Pain and erythema over the affected gland
• Purulent discharge from Stensen's duct
• Signs of dehydration
• Fever and other systemic symptoms

Treatment Algorithm for Acute Bacterial Suppurative Parotitis

First-line Treatment:

1. Hydration

   • Maintain adequate fluid intake to promote salivary flow
   • IV fluids may be necessary for severely dehydrated patients

2. Antimicrobial Therapy

   • Initial empiric therapy: Target S. aureus and anaerobic bacteria 1

     • First-line: Anti-staphylococcal penicillin (e.g., oxacillin, nafcillin) or first-generation cephalosporin
     • For penicillin-allergic patients: Clindamycin
     • For hospitalized patients: Consider broader coverage including gram-negative organisms

   • Duration: 7-10 days, or at least 48 hours after clinical resolution

3. Supportive Care

   • Analgesics and anti-inflammatories for pain management 2
   • Warm compresses to the affected area
   • Gland massage to promote drainage
   • Sialagogues (agents that promote salivary flow)

Second-line/Advanced Treatment:

1. Surgical Intervention

   • Indicated for:
     • Abscess formation
     • Failure to respond to medical management within 48-72 hours
     • Complications such as extension to adjacent spaces

2. Drainage Procedures

   • Needle aspiration or incision and drainage of fluctuant collections
   • Ultrasound guidance may be helpful

Management of Chronic Recurrent Parotitis

1. Conservative Management:

   • Gland massage and sialagogues 3
   • Adequate hydration
   • Antibiotics during acute exacerbations

2. Interventional Approaches:

   • Sialendoscopy with duct rinsing and cortisone instillation for more severe cases 3

3. Surgical Management:

   • Parotidectomy as last resort for refractory cases not responding to other treatments 4, 3

Special Considerations

Neonatal Suppurative Parotitis

• Requires prompt antimicrobial therapy
• Risk factors include dehydration, low birth weight, and immune suppression 5
• Ultrasound examination is helpful for diagnosis and monitoring 5

Prevention Strategies

• Maintain good oral hygiene
• Ensure adequate hydration
• Early treatment of bacterial infections of the oropharynx 1

Monitoring and Follow-up

• Regular assessment of clinical response within 48-72 hours of treatment initiation
• Imaging (ultrasound) for patients not responding to therapy or with suspected complications
• Long-term follow-up for patients with chronic recurrent parotitis

The management of parotitis requires prompt recognition and appropriate antimicrobial therapy. While most cases respond well to medical management, surgical intervention may be necessary for complicated cases or those not responding to conservative treatment.