Treatment of Parotitis
For acute bacterial parotitis, initiate empiric antimicrobial therapy targeting Staphylococcus aureus and anaerobes with parenteral antibiotics, combined with aggressive hydration and oral hygiene measures, while monitoring closely for abscess formation requiring surgical drainage. 1
Antimicrobial Therapy
Empiric Antibiotic Selection
Target pathogens: The most common organisms are Staphylococcus aureus and anaerobic bacteria (including pigmented Prevotella, Porphyromonas, Fusobacterium, and Peptostreptococcus species), with Streptococcus pneumoniae and gram-negative bacilli (particularly E. coli in hospitalized patients) also implicated. 1
Parenteral therapy is required for acute bacterial suppurative parotitis, with antibiotic selection based on the suspected or confirmed etiologic agent. 1
Penicillin achieves higher concentrations in purulent saliva from diseased parotid glands compared to healthy glands, making beta-lactam antibiotics particularly effective for this indication. 2
Surgical Intervention
Immediate surgical drainage is mandatory once an abscess has formed, as antimicrobial therapy alone will not resolve established collections. 1
For chronic parotitis refractory to medical management (characterized by recurrent painful swelling with purulent discharge), total parotidectomy with facial nerve dissection effectively eradicates recurring infections, though this should be considered early before fistulae or abscesses develop. 3
Supportive Care Measures
Hydration and Oral Hygiene
Maintain aggressive hydration to promote salivary flow and prevent stasis, which is fundamental to preventing and treating bacterial parotitis. 1
Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization and maintain oral hygiene. 4
Use antiseptic oral rinses containing 0.2% chlorhexidine digluconate or 1.5% hydrogen peroxide twice daily to decrease microbial load. 4
Pain Management Algorithm
First-line: Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, for anti-inflammatory and analgesic effects. 4
Second-line: Add topical anesthetic preparations such as viscous lidocaine 2% for inadequate pain control with anti-inflammatory agents alone. 4
Third-line: Escalate to systemic analgesics following the WHO pain management ladder for severe pain unresponsive to topical measures. 4
Additional Oral Care
Apply white soft paraffin ointment to the lips every 2-4 hours if perioral involvement is present. 4
Use mucoprotectant mouthwash (such as Gelclair) three times daily to protect ulcerated mucosal surfaces if oral mucositis accompanies parotitis. 4
Treat secondary candidal infection with nystatin oral suspension or miconazole oral gel if fungal overgrowth develops during the acute illness. 4
Viral Parotitis (Mumps)
Clinical Recognition
Mumps presents with bilateral or unilateral parotitis developing 16-18 days after exposure, often preceded by fever, headache, malaise, myalgia, and anorexia. 5
Only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic and up to 50% present with nonspecific respiratory symptoms. 5
Management Approach
Viral parotitis is self-limited and requires only supportive care with the oral hygiene and pain management measures outlined above, as antimicrobial therapy is not indicated. 5
Monitor for complications including orchitis (up to 38% of postpubertal males), aseptic meningitis (4-6% of cases), and rarely meningoencephalitis or sensorineural deafness. 5
Key Clinical Pitfalls
Do not delay surgical consultation when abscess formation is suspected, as antibiotics alone will fail and complications will worsen. 1
Gram-negative organisms predominate in hospitalized patients, requiring broader spectrum coverage than community-acquired cases. 1
Early surgical intervention for chronic parotitis prevents progression to fistulae and abscesses, which significantly complicate management. 3
Maintain good oral hygiene and adequate hydration as preventive measures, particularly in high-risk patients with decreased salivary flow or oropharyngeal infections. 1