What is the initial treatment for a salivary gland infection?

Initial Treatment for Salivary Gland Infection

The initial treatment for a salivary gland infection (sialadenitis) should include antibiotics effective against Staphylococcus aureus (most common pathogen), adequate hydration, salivary gland massage, and sialagogues to stimulate salivary flow. 1, 2

Diagnostic Approach

• Clinical presentation typically includes pain, swelling, skin erythema, gland edema, fever, and sometimes pus visible at the duct opening 1
• Diagnosis is primarily clinical, with bacteriological sampling recommended to guide antibiotic therapy 1
• Ultrasound should be performed if there is diagnostic uncertainty or signs of complications 1
• Bimanual palpation can help identify salivary stones, which may be the underlying cause of infection 3

Treatment Algorithm

First-Line Treatment

• Antibiotic therapy:

  • Start with empiric antibiotics targeting Staphylococcus aureus 2
  • Cephalosporins achieve the highest concentrations in saliva and cover the spectrum of bacteria implicated in sialadenitis 4
  • Fluoroquinolones are an alternative with good salivary penetration 4
  • Avoid phenoxymethylpenicillin and tetracyclines as they do not reach bactericidal levels in saliva 4
  • Continue antibiotics for 10 days, adjusting based on culture results 1

• Supportive measures:

  • Aggressive hydration to increase salivary flow, especially important in elderly patients 1, 2
  • Salivary gland massage to promote drainage 5
  • Sialagogues (lemon drops or vitamin C lozenges) to stimulate salivary flow 5
  • Warm compresses to reduce inflammation and pain 6
  • Pain management with appropriate analgesics 6

For Obstructive Causes

• If a salivary stone (sialolithiasis) is identified as the underlying cause:
  • Small stones may pass spontaneously with hydration and massage 6
  • Larger stones may require removal through minimally invasive techniques 3
  • Sialendoscopy is a gland-sparing technique that can treat obstructive disorders 6

Special Considerations

• Viral sialadenitis:

  • Treatment is symptomatic and typically resolves in 8-15 days 1
  • Focus on hydration, pain control, and supportive care 1

• Abscess formation:

  • If an abscess develops, surgical drainage may be necessary 2
  • Continue antibiotic therapy and supportive measures 2

• Chronic/recurrent sialadenitis:

  • Address underlying causes such as stones, strictures, or systemic diseases 5
  • Management focuses on relieving obstruction if present 5

Prevention of Recurrence

• Maintain adequate hydration 2
• Good oral hygiene 6
• Review medications that may cause xerostomia (dry mouth) 2
• Regular follow-up to monitor for recurrence or complications 6

Common Pitfalls

• Failure to identify and address underlying obstructive causes can lead to recurrent infections 6
• Inadequate hydration may prolong recovery and increase risk of complications 1
• Not obtaining cultures may result in ineffective antibiotic therapy if resistant organisms are present 1
• Delaying treatment can lead to abscess formation or spread of infection to adjacent structures 1