Acute bacterial parotitis

Case Definition:

Usually unilateral swelling of parotid gland with potential abscess formation. Can be associated with poor dental hygiene, dental caries and dehydration. The most common cause is Staph aureus  (could be meticillin resistant Staph aureus - MRSA).

 

Diagnostic criteria:

Parotid gland is acutely tender, swollen with inflammation of the soft tissues. Can be associated with trismus and a stone may be palpable in the parotid duct or visible on a plain X-ray.

 

Specimens to be collected:

  • Parotid duct pus swab for bacterial culture if pus seen from parotid duct

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A

Minor to moderate infection

Review doses in renal impairment

FLUCLOXACILLIN 500mg po qds
Plus
METRONIDAZOLE 400mg po tds (if anaerobic infection suspected/poor dentition)

OR,
If current/previous MRSA positive:

DOXYCYCLINE 200mg po od
Plus
METRONIDAZOLE 400mg po tds (if anaerobic infection suspected/poor dentition)

Typical duration 5 days

CLINDAMYCIN 450mg po qds

OR,
If current/previous MRSA positive:

DOXYCYCLINE 200mg po od
Plus
METRONIDAZOLE 400mg po tds (if anaerobic infection suspected/poor dentition)

 

 

Typical duration 5 days

B

Moderate to severe infection 

Review doses in renal impairment

FLUCLOXACILLIN 1g iv qds
Plus
METRONIDAZOLE 500mg iv tds

OR,

If current/previous MRSA positive use :

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-100kg: 600mg
>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Plus


METRONIDAZOLE 500mg iv tds

Typical duration 5 days (extending to 10 days in severe infection)

CLINDAMYCIN 1.2g iv qds

OR,

If current/previous MRSA positive use :

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-100kg: 600mg
>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Plus


METRONIDAZOLE 500mg iv tds

Typical duration 5 days (extending to 10 days in severe infection)

 C

Severe to life threatening infection 

Review doses in renal impairment

FLUCLOXACILLIN 1g iv qds
Plus
METRONIDAZOLE 500mg iv tds
Plus
GENTAMICIN 5mg/kg iv stat dose
(nb: use 3mg/kg if >65 years old)

If serum creatinine 150-300 micromol/L use:
GENTAMICIN 80-120mg IV stat
GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis and discuss with Consultant Microbiologist. Check level 12-18hrs after first dose. Continue according to local protocol if required.

OR,

If current/previous MRSA positive use:

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-100kg: 600mg
>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Plus
METRONIDAZOLE 500mg iv tds
Plus
GENTAMICIN 5mg/kg iv stat dose
(nb: use 3mg/kg if >65 years old)

If serum creatinine 150-300 micromol/L use:
GENTAMICIN 80-120mg IV stat
GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis and discuss with Consultant Microbiologist. Check level 12-18hrs after first dose. Continue according to local protocol if required.

Typical duration 5 days (extending to 10 days in severe infection)

CLINDAMYCIN 1.2g iv qds
Plus
GENTAMICIN 5mg/kg iv stat dose
(nb: use 3mg/kg if >65 years old)

If serum creatinine 150-300 micromol/L use:
GENTAMICIN 80-120mg IV stat
GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis and discuss with Consultant Microbiologist. Check level 12-18hrs after first dose. Continue according to local protocol if required.

OR,

If current/previous MRSA positive use:

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-100kg: 600mg
>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Plus
METRONIDAZOLE 500mg iv tds
Plus
GENTAMICIN 5mg/kg iv stat dose
(nb: use 3mg/kg if >65 years old)

If serum creatinine 150-300 micromol/L use:
GENTAMICIN 80-120mg IV stat
GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis and discuss with Consultant Microbiologist. Check level 12-18hrs after first dose. Continue according to local protocol if required.

Typical duration 5 days (extending to 10 days in severe infection)

IV to Oral Switch (explanatory notes See Severity Category A above

Typical duration 5 days (extending to 10 days in severe infection)

See Severity Category A above

Typical duration 5 days (extending to 10 days in severe infection)

Last reviewed 23/04/14

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)