Suppurative parotitis: Difference between revisions
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#Abx | #Abx | ||
##PO abx if pts can tolerate oral liquids and have no evidence of systemic illness | ##PO abx if pts can tolerate oral liquids and have no evidence of systemic illness | ||
##Amoxicillin-clavulanate OR clindamycin OR cephalexin + metronidazole | ##Amoxicillin-clavulanate OR clindamycin OR [[cephalexin]] + metronidazole | ||
##IV abx | ##IV abx | ||
###Indicated for trismus, inability to tolerate oral liquids, or immunocompromised | ###Indicated for trismus, inability to tolerate oral liquids, or immunocompromised | ||
Revision as of 07:37, 5 February 2014
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
DDX
Treatment
- Hydrate the volume-depleted patient
- Massage and apply heat to the affected gland
- Stimulate salivation using sialagogues such as lemon drops
- Abx
- PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
- Amoxicillin-clavulanate OR clindamycin OR cephalexin + metronidazole
- IV abx
- Indicated for trismus, inability to tolerate oral liquids, or immunocompromised
- Nafcillin OR ampicillin-sulbactam OR (vancomycin + metronidazole (if MRSA suspected))
See Also
Source
Tintinalli