From the Guidelines
Parotitis treatment primarily involves supportive care, including rest, adequate hydration, and pain management, as there is no specific antiviral treatment for mumps, the most common cause of viral parotitis, as noted in the 2017 Pediatrics study 1. The treatment approach for parotitis depends on the underlying cause, which can be viral or bacterial. For viral parotitis, such as mumps, the focus is on managing symptoms and supporting the body's natural recovery process. This includes:
- Rest to help the body recover
- Adequate hydration to prevent dehydration
- Warm or cold compresses to reduce swelling and discomfort
- Pain relievers such as acetaminophen (500-1000mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) to manage pain and reduce fever According to the 2017 study in Pediatrics 1, the diagnosis and treatment of parotitis involve clinical assessment and supportive care, with the goal of managing symptoms and preventing complications. Key aspects of parotitis treatment include:
- Addressing the underlying cause, whether viral or bacterial
- Providing supportive care to manage symptoms and prevent complications
- Considering the use of antibiotics for bacterial parotitis, such as amoxicillin-clavulanate or clindamycin, as appropriate
- Implementing supportive measures, including gentle massage of the gland, sour candies or lemon drops to stimulate saliva flow, maintaining good oral hygiene, and avoiding dehydration.
From the Research
Parotitis Treatment Options
- The management options for parotitis are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention 2.
- Surgical methods that have been described include injection of methyl violet - a sclerosing agent, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy 2.
- Parotidectomy is considered the ultimate surgical option but because of its significant morbidity, the exact technique and procedure that should be used remains contentious 2.
Diagnosis and Assessment
- Sialography remains the investigation of choice for chronic parotitis, but diagnostic sialendoscopy may complement or supersede sialography as the diagnostic procedure of choice 2.
- Assessment of the disease process should differentiate local primary parotid infection from systemic infection when this gland is also involved as part of a generalized inflammatory condition 3.
- Pus, aspirated from a suppurative parotic abscess, should be plated on media that are supportive for the growth of aerobic and anaerobic bacteria, mycobacteria, and fungi 3.
Causes and Predisposing Factors
- Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses 3.
- Acute suppurative parotitis is generally caused by Staphylococcus aureus, Streptococcus species, and rarely, gram-negative bacteria 3.
- Predisposing factors to suppurative infections are dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation 3.
- Drug-induced parotitis is a relatively uncommon adverse drug reaction, with medications such as phenylbutazone, oxyphenbutazone, and antipsychotics (particularly thioridazine) implicated in causing parotitis 4, 5.
Treatment Approaches
- Early and proper antimicrobial therapy may prevent suppuration, and initial empiric therapy that is directed against both aerobic and anaerobic bacteria may be required until a specific causal diagnosis is available 3.
- Surgical drainage may be indicated when pus has formed, and this may prevent complications and facilitate recovery 3.