Treatment of Parotitis
Treatment of parotitis centers on meticulous oral hygiene, pain management, and antimicrobial therapy when bacterial infection is present, with supportive care measures forming the foundation of management regardless of etiology. 1
Initial Supportive Care Measures
The cornerstone of parotitis management involves aggressive oral hygiene protocols:
Implement oral rinses with saline or sodium bicarbonate solution (1 teaspoon salt with three-quarters teaspoon bicarbonate in 500 mL water) 4-6 times daily to reduce bacterial colonization and prevent complications. 1, 2
Use alcohol-free mouthwashes exclusively, as alcohol-containing products exacerbate mucosal injury and worsen inflammation. 1
Consider adding 0.2% chlorhexidine digluconate mouthwash twice daily for enhanced antimicrobial coverage, particularly in moderate to severe cases. 1, 2
Maintain adequate hydration throughout treatment, as dehydration may contribute to recurrent episodes. 3, 4
Pain Management Algorithm
Follow this stepwise approach for pain control:
First-line: Apply benzydamine hydrochloride oral rinse or spray every 3 hours, especially before meals, for anti-inflammatory and analgesic effects. 1, 2, 5
Second-line: Add topical anesthetic preparations such as viscous lidocaine 2% if anti-inflammatory agents provide inadequate relief. 2, 5
Third-line: Escalate to systemic analgesics following the WHO pain management ladder for severe pain unresponsive to topical measures. 1, 2, 5
Alternative for moderate pain: Consider topical NSAIDs (5% amlexanox oral paste) as an intermediate option. 1, 2
Antimicrobial Therapy
Bacterial Parotitis
The choice of antimicrobial agent depends on the identified or suspected pathogen:
Staphylococcus aureus and anaerobic bacteria (including pigmented Prevotella, Porphyromonas, Fusobacterium, and Peptostreptococcus species) are the most common pathogens in acute bacterial suppurative parotitis. 4
Streptococcus species (including S. pneumoniae) and gram-negative bacilli (E. coli, Klebsiella pneumoniae) are also encountered, particularly in hospitalized patients. 4
Parenteral antimicrobial therapy is required for acute bacterial parotitis, with agent selection based on culture results when available. 4
If an abscess forms, surgical drainage is mandatory in addition to antimicrobial therapy. 1, 4
Viral Parotitis (Mumps)
Viral parotitis is self-limited and requires only supportive care—antimicrobial therapy is not indicated. 5
Monitor for complications including orchitis, aseptic meningitis, meningoencephalitis, or sensorineural deafness. 5
Note that only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic. 5
Dietary Modifications
Consume only soft, moist, non-irritating foods that are easy to chew and swallow. 1
Avoid acidic, spicy, salty, or rough foods that increase irritation and delay healing. 1
Additional Oral Care Measures
Eliminate sharp edges or ill-fitting dental prostheses that perpetuate mucosal trauma. 1
Apply white soft paraffin ointment to the lips every 2-4 hours if perioral involvement is present. 2, 5
Consider saliva substitutes if xerostomia (dry mouth) is present. 1
Use mucoprotectant mouthwash (such as Gelclair) three times daily to protect ulcerated mucosal surfaces if oral mucositis accompanies parotitis. 2, 5
Management of Secondary Infections
- For Candida infection, treat with nystatin oral suspension or miconazole oral gel if fungal overgrowth develops during acute illness. 1, 2, 5
Critical Pitfalls to Avoid
Never administer corticosteroids before ensuring adequate antimicrobial coverage, as steroids can worsen underlying anaerobic infection. 1
Avoid all alcohol-containing oral products that aggravate mucosal lesions. 1
Hospitalization Criteria
Admit patients who meet any of the following criteria:
- Inability to maintain oral intake 1
- Severe tissue necrosis 1
- Systemic signs of infection (fever, sepsis) 1
Follow-up and Long-term Management
Continue meticulous daily oral hygiene even after clinical resolution to prevent recurrence. 1
Monitor for complete healing with intact epithelium and resolution of necrotic ulcers. 1
For recurrent parotitis in children, expect symptoms to peak during early school years (ages 3-6) and typically subside by puberty, with most patients symptom-free by age 22. 3
Consider interventional radiology procedures (stone removal with Dormia basket, balloon dilation of strictures) or sialography for recurrent cases before resorting to surgical options. 6
Reserve aggressive surgical interventions (parotid duct ligation, parotidectomy, tympanic neurectomy) only for adults with persistent, refractory symptoms. 3, 7