What is the treatment for a patient with parotitis?

Treatment of Parotitis

The treatment of parotitis centers on meticulous oral hygiene with saline or sodium bicarbonate rinses 4-6 times daily, pain management with benzydamine hydrochloride oral rinses every 3 hours, and antimicrobial therapy when bacterial infection is present, with the specific antibiotic choice guided by the causative organism. 1, 2, 3

Initial Supportive Care Measures

Oral Hygiene Protocol:

• Implement daily mouth cleaning with warm 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, 3
• Use only alcohol-free mouthwashes, as alcohol-containing products exacerbate mucosal lesions 1
• Add 0.2% chlorhexidine digluconate mouthwash or 1.5% hydrogen peroxide mouthwash twice daily for additional antimicrobial coverage in moderate to severe cases 1, 2, 3

Lip and Mucosal Protection:

• Apply white soft paraffin ointment to lips every 2-4 hours if perioral involvement is present 2, 3
• Use mucoprotectant mouthwash (such as Gelclair) three times daily to protect ulcerated mucosal surfaces 2, 3
• Consider saliva substitutes if xerostomia develops 1

Pain Management Algorithm

First-Line: Initiate benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, for anti-inflammatory and analgesic effects 1, 2, 3

Second-Line: If pain control is inadequate with anti-inflammatory agents alone, add topical anesthetic preparations such as viscous lidocaine 2% 2, 3

Third-Line: For severe pain unresponsive to topical measures, escalate to systemic analgesics following the WHO pain management ladder 1, 2, 3

Alternative for Moderate Pain: Consider topical NSAIDs such as 5% amlexanox oral paste 1, 2

Antimicrobial Therapy

Bacterial Parotitis:

• The choice of antimicrobial agent depends on the identified etiologic organism 1, 4
• The most common pathogens are Staphylococcus aureus and anaerobic bacteria (including pigmented Prevotella, Porphyromonas species, Fusobacterium species, and Peptostreptococcus species) 4
• Streptococcus species and gram-negative bacilli (including E. coli) are also encountered, particularly in hospitalized patients 4
• Administer parenteral antimicrobial therapy with adequate coverage for both gram-positive and anaerobic organisms 4

Critical Warning: Never use corticosteroids before ensuring adequate antimicrobial coverage, as steroids can worsen underlying anaerobic infection 1

Viral Parotitis (Mumps):

• Viral parotitis is self-limited and requires only supportive care with oral hygiene and pain management measures outlined above 3
• Antimicrobial therapy is not indicated for viral parotitis 3
• Monitor for complications including orchitis, aseptic meningitis, and rarely meningoencephalitis or sensorineural deafness 3

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 1

Additional Oral Care Considerations

• Eliminate any sharp edges or ill-fitting dental prostheses, as these sources of trauma perpetuate the condition 1
• Maintain adequate hydration throughout treatment 4

Management of Complications

Abscess Formation: If an abscess develops, surgical drainage is required 1, 4

Secondary Candidal Infection: Treat with oral nystatin suspension or miconazole oral gel if fungal overgrowth develops 1, 2, 3

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 1

Follow-Up Care

• Continue meticulous daily oral hygiene even after clinical resolution to prevent recurrence 1
• Monitor for healing with intact epithelium and resolution of necrotic ulcers 1

Chronic or Recurrent Parotitis

For patients with chronic parotitis who fail prolonged medical management, surgical interventions including parotidectomy may ultimately be required, though this represents a last resort due to significant morbidity 5, 6