Suppurative parotitis: Difference between revisions

Revision as of 13:37, 13 April 2015

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

Treatment targeted at S. aureus, gram negative bacilli, mumps, enteroviruses, and influenza virus

Tintinalli

Authors:

@@ Line 31: / Line 31: @@
 ==Treatment==
+===Supportive Care===
 #Hydrate the volume-depleted patient
 #Massage and apply heat to the affected gland
 #Stimulate salivation using sialagogues such as lemon drops
-#Abx
+===[[Antibiotic]] Options===
-##PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
+''Treatment targeted at S. aureus, gram negative bacilli, mumps, enteroviruses, and influenza virus''
-##Amoxicillin-clavulanate OR clindamycin OR [[cephalexin]] + metronidazole
+*[[Amoxicillin/Clavulanate]] 875mg (45mg/kg) PO BID OR
-##IV abx
+*[[Clindamycin]] 450mg PO three times daily or 10mg/kg PO four times daily
-###Indicated for trismus, inability to tolerate oral liquids, or immunocompromised
+*[[Dicloxacillin]] 500mg (7.5mg/kg) PO four times daily
-###Nafcillin OR ampicillin-sulbactam OR ([[vancomycin]] + metronidazole (if MRSA suspected))
+*[[Cephalexin]] 500mg (12.5mg/kg) PO four times daily
+*[[Nafcillin]] 2g IV six times daily  or 50mg/kg IV four times daily
+*[[Vancomycin]] 15-20mg/kg IV BID daily
 ==See Also==