Suppurative Parotitis

Triggers- Elderly, postoperative, dehydrated or intubated, recent intensive teeth cleaning, use of anticholinergic drugs, other drugs that reduce salivary flow, malnutrition, salivary calculi with obstruction, neoplasm of the oral cavity

Classical Presentation- tender, firm, red swelling of the pre- and post-auricular areas to angle of the mandible, trismus , dysphagia, high fevers, chills, SIRS
Purulence from Stensen’s duct >50%

Bugs by % identified in suppurative parotitis)-
Aerobes (34 %): S. aureus> Viridans strep> H. flu
Anaerobic  (41 %): Pigmented Prevotella, Porphyromonas spp, Fusobacterium spp, and Peptostreptococcus spp
Mixed aerobic /anaerobic bacteria ( 25%)
Gram Negatives: Enterobacteriaceae, Eikenella corrodens, and other gram-negative bacilli in hospitalized patients

Empiric Parotitis Antiobiotic Regimen in the immunocompetent host:
Nafcillin or Vancomycin + Metronidazole or Clindamycin to cover the above aerobes and anaerobes
In immunocompromised, those who have been hospitalized or on broad abx, consider pseudomonas and ESBL-producing organisms

(Ellen Eaton MD, 3/10/11)