Treatment of Parotitis
The treatment of parotitis should include antimicrobial therapy targeting Staphylococcus aureus and anaerobic bacteria, along with supportive measures including hydration, pain management, and warm compresses. 1
Initial Management
Supportive Measures
- Maintain adequate hydration to promote salivary flow and reduce bacterial colonization 1
- Apply warm compresses to the affected parotid gland to improve circulation and reduce inflammation 2
- Use bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times daily to maintain oral hygiene 3
- Consider sugarless chewing gum or candy to stimulate salivary flow, particularly in cases with oral dryness 3
Antimicrobial Therapy
- Initial empiric antibiotic therapy should target Staphylococcus aureus and anaerobic bacteria, the most common pathogens in acute bacterial parotitis 1
- For outpatient treatment, amoxicillin/clavulanate is recommended as first-line therapy due to its coverage of both S. aureus and anaerobic bacteria 3
- For hospitalized patients or those with severe infection, consider parenteral antibiotics with coverage for gram-negative organisms, which are more common in this population 1
- Continue antibiotic therapy for 7-10 days, with reassessment after 72 hours to determine response 3
Pain Management
- For mild to moderate pain, use topical NSAIDs (e.g., amlexanox 5% oral paste) 3
- When NSAIDs are not tolerated, consider acetaminophen (paracetamol) 3
- For more severe pain, consider systemic analgesics following the WHO pain management ladder 3
- Topical anesthetics such as viscous lidocaine 2% may provide temporary relief 3
Management of Specific Types of Parotitis
Acute Bacterial Suppurative Parotitis
- Administer parenteral antimicrobial therapy targeting S. aureus and anaerobic bacteria 1
- If an abscess has formed, surgical drainage is required 1
- Monitor for clinical improvement within 72 hours; if worsening, consider changing antimicrobial therapy or surgical intervention 3
Chronic Recurrent Parotitis
- Initial acute flares should be treated with a course of antibiotics 4
- For recurrent episodes, consider:
- Sialendoscopy with cortisone irrigation, which has shown effectiveness in reducing recurrent episodes and pain intensity 4
- Topical high potency corticosteroids for symptomatic relief: dexamethasone mouth rinse (0.1 mg/ml) for widespread involvement or clobetasol gel/ointment (0.05%) for limited locations 3
- For highly symptomatic or recurrent cases, systemic corticosteroids may be considered: prednisone/prednisolone (30-60 mg or 1 mg/kg) for 1 week followed by tapering over the second week 3
Refractory Cases
- For cases not responding to medical management, consider:
Special Considerations
Parotitis in Cancer Patients
- For cancer-related parotitis or mucositis, increase frequency of sodium bicarbonate containing mouthwash up to hourly as needed 3
- Consider prophylactic mouth rinses with ingredients such as sodium bicarbonate for prevention of mucositis in patients undergoing cancer treatment 3
- For radiation-induced parotitis, maintain good oral hygiene and consider saliva substitutes 3
Prevention
- Maintain good oral hygiene to reduce bacterial colonization 1
- Ensure adequate hydration to promote salivary flow 1
- Prompt treatment of bacterial infections of the oropharynx may reduce the occurrence of suppurative parotitis 1
Monitoring and Follow-up
- Reassess after 72 hours of antibiotic therapy to determine response 3
- For chronic or recurrent parotitis, consider imaging studies such as sialography or ultrasound to evaluate for ductal abnormalities or stones 2
- Monitor for complications such as abscess formation, which would require surgical intervention 1