Suppurative parotitis: Difference between revisions
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Revision as of 03:06, 26 July 2016
Background
- Serious bacterial infection of parotid gland that occurs in patients with 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
Differential Diagnosis
Facial Swelling
- Buccal space infections
- Dental problems
- Canine space infection
- Facial cellulitis
- Herpes zoster
- Masticator space infections
- Maxillofacial trauma
- Neoplasm
- Parapharyngeal space infection
- Salivary gland diagnoses
- Parotitis
- Ranula
- Sialoadenitis
- Sialolithiasis
- Superior vena cava syndrome
Evaluation
- Usually clinical
Management
Supportive Care
- Hydrate the volume-depleted patient
- Massage and apply heat to the affected gland
- Stimulate salivation using sialagogues such as lemon drops
Antibiotic Options
Treatment targeted at S. aureus, gram negative bacilli, mumps, enteroviruses, and influenza virus
- Amoxicillin/Clavulanate 875mg (45mg/kg) PO BID OR
- Clindamycin 450mg PO three times daily or 10mg/kg PO four times daily
- Dicloxacillin 500mg (7.5mg/kg) PO four times daily
- 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