Overview of acute suppurative sialadenitis
Acute suppurative sialadenitis (including parotitis) is usually caused by Staphylococcus aureus, though occasionally it is polymicrobial in adultsDanstrup, 2020. Infected salivary glands are enlarged, and often hot and tense. Pus may be expressed from the gland duct. Usually, patients are systemically unwell, dehydrated and have difficulty swallowing. They may also have sepsis or septic shock.
Management of acute suppurative sialadenitis includes:
- urgent referral to hospital for surgical review1
- rehydration
- culture and susceptibility testing of blood samples
- intraductal or surgical drainage if the swelling is fluctuant; send pus for culture and susceptibility testing
- antibiotic therapy, which is given intravenously initially then orally once the patient can swallow.
If blood culture results are positive for S. aureus, treat as S. aureus bacteraemia. If blood culture results indicate a polymicrobial bacteraemia, seek expert advice.
For patients with sepsis or septic shock, broad-spectrum intravenous empirical therapy is required – see Choice of empirical antibiotic regimen for sepsis or septic shock. Start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.