Acute Bacterial Sialoadenitis

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Bacterial infection usually of the parotid glands. It is mostly unilateral. Seen exclusively in debilitated, elderly, dehydrated patients or who have drug or disease-induced xerostomia.   

Cause

  • Staphylococcus aureus
  • Anaerobes
  • Streptococcus (occasionally)

Symptoms

  • Painful parotid swelling of sudden onset
  • Fever
  • Chills 

Signs

  • Erythematous swelling
  • Tense and shiny overlying skin
  • Purulent discharge from duct 

Investigations

  • FBC
  • Culture and sensitivity of discharge

TreatmentTreatment Objectives

  • To treat infection 
  • To provide pain relief 

Non-pharmacological treatment 

  • Encourage bed-rest
  • Adequate fluid intake 
  • Discontinue medications that can cause xerostomia
  • Surgical drainage if indicated

Pharmacological treatment 

For treatment of infection

1st Line Treatment

Evidence Rating: [B]

  • Flucloxacillin, oral, 

Adults

500 mg 6 hourly for 7-10 days

Children 

5-12 years; 250 mg 6 hourly for 7-10 days

1-5 years; 125 mg 6 hourly for 7-10 days

< 1 year; 62.5 mg 6 hourly for 7-10 days

For treatment of infection in patients with penicillin allergy

Evidence Rating: [C]

  • Clindamycin, oral,

Adults

150-300 mg 6-8 hourly for 7 days

Children

12-18 years; 150-300 mg 6 hourly for 7 days

1 month-11 years; 3-6 mg/kg 6 hourly for 7 days

For pain relief 

  • Paracetamol, oral, 

Adults

500 mg-1 g 6 hourly as required 

Children

6-12 years; 250-500 mg 6 hourly as required

1-5 years; 125-250 mg 6 hourly as required

3 months-1 year; 62.5-125 mg 6 hourly as required

Referral Criteria

Refer to a dentist after initiation of treatment.