• Most cases of bacterial parotitis are in frail elderly patients with dehydration.
  • Consider mumps.
  • Consider non-infective causes.
  • Patients with a persistent (>2 weeks) symptoms or unexplained parotid swelling or suspected parotid duct calculi should be referred to ENT.

Required investigations

  • Swab of parotid duct site for bacterial culture.
  • Blood cultures if febrile.
  • Consider mumps - send a viral swab of parotid duct/cheek for Mumps PCR.

Antimicrobial recommendations

Recommended total duration: 7 days

Oral route available and no signs of sepsisSigns of sepsis
Antimicrobial recommendation

Flucloxacillin 500mg every 6 hours orally

PLUS

Metronidazole 400mg every 8 hours orally

Flucloxacillin 2g every 6 hours IV

PLUS

Metronidazole 400mg every 8 hours orally
Penicillin Allergy/previous MRSA

Doxycycline 100mg every 12 hours orally

PLUS

Metronidazole 400mg every 8 hours orally

Vancomycin (use NHS Lothian Calculator located AMT intranet page) choose trough 10-15mg/L

PLUS

Metronidazole 400mg every 8 hours orally

IV to oral switch

Antimicrobial recommendation

Flucloxacillin 500mg every 6 hours orally

PLUS

Metronidazole 400mg every 8 hours orally
Penicillin Allergy/previous MRSA

Doxycycline 100mg every 12 hours orally

PLUS

Metronidazole 400mg every 8 hours orally

Notes

Likely organisms: Staphylococcus aureus, anaerobes.