From the Guidelines
The management of sialadenitis with abscess formation involves a combination of medical and surgical interventions, with surgical drainage being the primary treatment for abscesses, as recommended by the 2018 WSES/SIS-E consensus conference 1.
Key Considerations
- Initial treatment should include broad-spectrum antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily) or clindamycin (300-450 mg four times daily) for 7-10 days to address the infection, as suggested by the Infectious Diseases Society of America guidelines 1.
- Adequate hydration and sialagogues (such as lemon drops or sugar-free candies) should be encouraged to stimulate salivary flow.
- Pain management with NSAIDs or acetaminophen is recommended.
Surgical Intervention
- For the abscess itself, surgical drainage is essential and should not be delayed once the diagnosis is confirmed, as emphasized by the 2018 WSES/SIS-E consensus conference 1.
- This can be performed via intraoral or external approaches depending on the location and extent of the abscess.
- Following drainage, warm compresses applied to the affected area 3-4 times daily can help reduce inflammation.
Special Considerations
- In cases involving sialolithiasis (stones), removal of the stones may be necessary through sialendoscopy or open surgical techniques.
- Patients should be followed up within 48-72 hours after initial treatment to assess response.
- This approach combines antimicrobial therapy to control infection with mechanical drainage of purulent material, addressing both the infectious process and its complications while preserving gland function when possible.
Antibiotic Therapy
- Empiric therapy for community-acquired MRSA (CA-MRSA) should be recommended for patients at risk for CA-MRSA or who do not respond to first-line therapy, as suggested by the 2018 WSES/SIS-E consensus conference 1.
- The choice of antibiotic should be guided by local resistance patterns and the severity of the infection.
From the Research
Management of Sialadenitis with Abscess Formation
The management of sialadenitis with abscess formation involves a combination of medical and surgical interventions.
- The treatment of bacterial sialadenitis is based on probabilistic antibiotic therapy, which is then adapted based on the results of bacteriological sampling, for a duration of 10 days 2.
- Rehydration is essential, especially in elderly patients 2.
- In cases where an abscess develops, surgical treatment may become necessary, such as urgent surgical drainage of the abscess 3.
- The use of sialendoscopy, extracorporeal shock-wave lithotripsy, and salivary duct incision are modern treatment options that can help preserve the affected gland 4.
Antibiotic Therapy
- The most frequent germ responsible for sialadenitis is Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA) 5, 2, 3.
- Antibiotic treatment should be according to antibiogram, and the treatment duration is typically 10 days 5, 2.