What is the treatment for salivary gland infection?

Treatment of Salivary Gland Infection

Salivary gland infections should be treated with cephalosporins or fluoroquinolones as first-line antibiotics, combined with supportive measures including hydration, salivary gland massage, and sialagogues to stimulate saliva flow.

Etiology and Diagnosis

• Most common causative organism: Staphylococcus aureus 1
• Other pathogens: Various aerobic and anaerobic bacteria 1
• Predisposing factors:
  • Dehydration
  • Xerogenic medications
  • Ductal obstruction (e.g., sialolithiasis)
  • Reduced saliva secretion 1

Treatment Algorithm

First-Line Treatment

1. Antibiotic therapy:

   • Preferred antibiotics: Cephalosporins or fluoroquinolones 2
     • These antibiotics achieve the highest concentrations in saliva
     • Concentrations exceed the minimal inhibitory concentrations of bacteria commonly implicated in sialadenitis
   • Not recommended: Phenoxymethylpenicillin and tetracyclines (insufficient salivary concentrations) 2

2. Supportive measures:

   • Adequate hydration to increase saliva production 3, 4
   • Salivary gland massage to promote drainage 3, 4
   • Sialagogues (saliva stimulants):
     • Lemon drops
     • Vitamin C lozenges 3
   • Warm compresses to reduce inflammation

For Severe or Complicated Cases

1. If abscess formation occurs:

   • Surgical drainage may be necessary 4
   • Continue antibiotic therapy based on culture results

2. For recurrent infections:

   • Identify and address underlying causes (stones, strictures)
   • In cases of persistent recurrence, total excision of the affected salivary gland and its duct may be required 4

Special Considerations

• Sialolithiasis (salivary stones): If present, management should focus on relieving the obstruction 3, 5
• Chronic sialadenitis: More likely to be inflammatory than infectious; treatment directed at underlying cause 3

Monitoring and Follow-up

• Assess response to treatment within 48-72 hours
• If no improvement, consider:
  • Alternative antibiotics
  • Imaging to rule out abscess formation or obstruction
  • Specialist referral (oral surgeon, otolaryngologist)

Prevention of Recurrence

• Maintain good hydration
• Practice good oral hygiene
• Regular dental check-ups
• Avoid medications that cause dry mouth when possible

Pitfalls and Caveats

• Failure to identify and address underlying obstructions can lead to treatment failure and recurrence
• Inadequate antibiotic coverage may result in persistent infection
• Rare forms of bacterial sialadenitis (actinomycosis, tuberculosis) may mimic salivary gland tumors and require specific treatment approaches 1
• Viral etiologies (mumps, HIV) require different management strategies focused on the underlying disease 3