Treatment of Parotitis
Parotitis treatment requires a combination of supportive care measures, pain management, antimicrobial therapy when bacterial infection is present, and surgical drainage if abscess formation occurs.
Immediate Supportive Care Measures
- Maintain adequate hydration to promote salivary flow and prevent further gland obstruction 1
- Apply warm compresses to the affected gland to reduce pain and promote drainage 1
- Encourage oral intake and use sialagogues (lemon drops, sour candies) to stimulate salivary flow 1
- Maintain good oral hygiene with warm saline mouthwashes 4-6 times daily to reduce bacterial colonization 2
- Use antiseptic oral rinses such as 0.2% chlorhexidine digluconate mouthwash twice daily 3, 4
Pain Management Algorithm
First-line approach:
- Use anti-inflammatory oral rinses containing benzydamine hydrochloride every 3 hours, particularly before eating 3
- Apply topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) for direct pain relief 3, 4
Second-line for moderate pain:
- Consider topical NSAIDs such as amlexanox 5% oral paste 3
Third-line for severe pain:
Antimicrobial Therapy for Bacterial Parotitis
When bacterial infection is suspected or confirmed, parenteral antimicrobial therapy is required 1. The choice depends on the clinical setting:
Community-acquired bacterial parotitis:
- Target Staphylococcus aureus and anaerobic bacteria (pigmented Prevotella, Porphyromonas spp., Fusobacterium spp., Peptostreptococcus spp.) 1
- Use anti-staphylococcal agents with anaerobic coverage 1
Hospital-acquired or ICU-associated parotitis:
- Gram-negative organisms including Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae are more common 1, 5, 6
- Broader spectrum coverage with antipseudomonal agents may be necessary 6
Important caveat: Culture parotid fluid or blood when possible to guide targeted antimicrobial therapy, as outcomes are worse in adults with gram-negative infections 5, 6
Surgical Intervention
Surgical incision and drainage is required once an abscess has formed 1. Key considerations:
- Early surgical drainage (within 9 days of symptom onset) leads to rapid resolution of disease 6
- Interventional radiology procedures can be used for stone removal (Dormia basket) or stricture dilation (balloon catheter) in recurrent parotitis 7
- Parotidectomy may be necessary for chronic parotitis refractory to prolonged medical management 8
- Be aware of facial nerve damage risk with surgical approaches 7
Additional Oral Care Measures
- Apply white soft paraffin ointment to the lips if affected 3, 4
- Use mucoprotectant mouthwash (such as Gelclair) three times daily to protect ulcerated mucosal surfaces 3
- Treat secondary candidal infection with nystatin oral suspension or miconazole oral gel if present 3, 2