Antibiotic Treatment for Large, Swollen Maxillary Gland

Amoxicillin-clavulanate is the first-line antibiotic treatment for a large, swollen maxillary gland due to suspected bacterial infection. 1

First-Line Treatment Options

Amoxicillin-clavulanate is the recommended first-choice antibiotic for maxillary sinusitis, which commonly presents with swelling and pain in the maxillary area 1
The typical symptoms of maxillary sinusitis include unilateral or bilateral infraorbital pain that increases when the head is bent forward, sometimes pulsatile and peaking in the early evening and at night 1
For adults, the standard dosing of amoxicillin-clavulanate should be administered for 7-10 days 1
For children, the recommended dosage is amoxicillin-clavulanate 80 mg/kg/day in three doses, not exceeding 3 g/day 1

For patients with penicillin allergy, the following alternatives are recommended:
- Second-generation oral cephalosporins such as cefuroxime-axetil 1
- Third-generation oral cephalosporins such as cefpodoxime-proxetil or cefotiam-hexetil 1
- Pristinamycin (particularly recommended in case of beta-lactam allergy) 1
Clindamycin may be considered for penicillin-allergic patients with infections caused by susceptible streptococci, pneumococci, and staphylococci 2

The standard duration of treatment is 7-10 days for adults 1
Cefuroxime-axetil and cefpodoxime-proxetil have demonstrated efficacy with a shorter 5-day course 1
For children, the standard duration is also 7-10 days 1

Fluoroquinolones active against pneumococci (levofloxacin, moxifloxacin) should be reserved for situations with high risk of complications or failure of first-line therapy 1
Immediate antibiotic therapy is indicated in severe acute forms of purulent maxillary sinusitis 1
For maxillary sinusitis of dental origin (unilateral maxillary sinusitis associated with an upper unilateral dental infection), antibiotic therapy is specifically indicated 1
Amoxicillin-clavulanate has been shown to be comparable to clindamycin in achieving clinical success (88.2% versus 89.7%) in acute odontogenic infections 3

Clinical signs suggestive of complicated sinusitis requiring hospitalization include:
- Meningeal syndrome
- Exophthalmos
- Palpebral edema
- Ocular mobility disorders
- Severe pain preventing sleep 1
These complications require parenteral antibiotic therapy and immediate referral to hospital 1

Amoxicillin-clavulanate shows good activity against the main pathogens associated with maxillary infections, including penicillin-susceptible and intermediate strains of Streptococcus pneumoniae, and beta-lactamase producing strains of Haemophilus influenzae and Moraxella catarrhalis 4
Clinical studies have demonstrated high success rates (93%) with amoxicillin-clavulanate given every 12 hours for the treatment of acute bacterial maxillary sinusitis 5
Twice-daily dosing of amoxicillin-clavulanate has been shown to be as effective as three-times-daily dosing, potentially improving patient compliance 5