Suppurative parotitis is a serious bacterial infection that occurs in patients with diminished salivary flow. Retrograde transmission of bacteria leads to infection. Factors that lead to decreased salivary flow include recent anesthesia, dehydration, prematurity, advanced age, medications (eg, diuretics, β-blockers, antihistamines, phenothiazines, and tricyclic antidepressants), and certain disorders (Sjögren syndrome, diabetes, hypothyroidism, and human immunodeficiency virus). Clinical features may include fever, trismus, erythema, and pain over the parotid gland. Pus may be expressed from Stensen duct.
The diagnosis is clinical. Ultrasound or CT may be ordered if an abscess is suspected. Treatment should optimize salivary flow by using sialogogues such as lemon drops and stopping any medications that cause dry mouth. Oral antibiotics (see Tables 150-1 and 150-2) are appropriate for those tolerating oral intake, and without trismus. Hospitalization is appropriate for those with signs of systemic illness, inability to tolerate oral intake, or those that have failed outpatient therapy. Close follow-up should be arranged.