Suppurative parotitis

Background

• Serious bacterial infection of parotid gland that occurs in pts w/ decreased salivary flow
  • Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma
  • Usually caused by staph, strep, anerobes
• Risk factors:
  • Dehydration
  • Prematurity or advanced age
  • Sialolithiasis
  • Oral neoplasms
  • Salivary duct strictures
  • Meds (cause systemic dehydration or decrease salivary flow)
    • Diuretics
    • Antihistamines
    • TCAs
    • B-blockers
  • Chronic illnesses
    • HIV
    • Sjogren syndrome
    • Anorexia/bulimia

Clinical Features

• Rapid onset
• Skin over parotid gland is red and tender
• Purulent drainage from Stensen's duct
• Fever
• Trismus

Treatment

1. Hydrate the volume-depleted patient
2. Massage and apply heat to the affected gland
3. Stimulate salivation using sialagogues such as lemon drops
4. Abx
   1. PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
   2. Amoxicillin-clavulanate OR clindamycin OR cephalexin + metronidazole
   3. IV abx
      1. Indicated for trismus, inability to tolerate oral liquids, or immunocompromised
      2. Nafcillin OR ampicillin-sulbactam OR (vancomycin + metronidazole (if MRSA suspected))

See Also

Salivary Gland Infections

Source

Tintinalli