Intravenous antibiotic therapy for acute suppurative sialadenitis

Start empirical intravenous antibiotic therapy for acute suppurative sialadenitis, in conjunction with local intervention or drainage, use:

flucloxacillin 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin intravenous dosage adjustment. Switch to oral therapy once the patient can swallow. flucloxacillin flucloxacillin flucloxacillin

For patients with risk factors for methicillin-resistant S. aureus (MRSA) infection, use:

vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults or Intermittent vancomycin dosing for young infants and children. Switch to oral therapy once the patient can swallow. vancomycin vancomycin vancomycin

In some regions, based on local community-acquired MRSA susceptibility patterns, clindamycin is a suitable alternative to vancomycin. Use:

clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, 8-hourly; switch to oral therapy once the patient can swallow¹. clindamycin clindamycin clindamycin

For patients without risk factors for MRSA who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use:

cefazolin 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. Switch to oral therapy once the patient can swallow. cefazolin cefazolin cefazolin

For patients without risk factors for MRSA who have had a severe immediate² hypersensitivity reaction to a penicillin, cefazolin (at the dosage above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For patients who have had a severe immediate² hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for patients who have had a severe delayed³ hypersensitivity reaction to a penicillin, use vancomycin as above.

Modify therapy based on the results of culture and susceptibility testing.

¹ There are more clinical and microbiological data to support the use of clindamycin than lincomycin. Intravenous lincomycin can be used at the same dosage if clindamycin is unavailable or if a local protocol recommends its use.Return

² Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

³ Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return