# Acute suppurative sialadenitis (parotitis) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: IDSA Guidelines · Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) ## Treatment metadata - Amoxicillin + Clavulanic acid — 875 mg — oral.solid - Clindamycin — 300 mg — oral.solid ## Complete treatment card ```text ACUTE SUPPURATIVE SIALADENITIS (PAROTITIS) Sources: IDSA Guidelines · Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Acute bacterial: one-sided swelling that grows steadily more painful - Pain on chewing and difficulty opening the mouth [jaw pain] - Fever and chills are common [chills · fever] - Mumps opens with fever, headache, malaise and aching muscles, gland swelling following within two days [fever · headache · malaise · muscle pain] - Stone: swelling that comes and goes and hurts, brought on by eating - Roughly a third have painless swelling; about one in ten hurt with nothing to see - Juvenile recurrent parotitis: repeated painful bouts of one or two days, occasionally two weeks - Tuberculous gland comes with weight loss, night sweats, chest pain and coughing blood [chest pain · cough · night sweats · weight loss] - A sore throat, tiredness and loss of appetite can come with the swelling [fatigue · poor appetite · sore throat] SIGNS - what you find (11) - A normal gland feels soft, smooth and non-tender, and is usually impalpable - Gentle pressure on a normal gland yields clear saliva - Redness of the skin over the gland [redness] - Pus can be milked from the Stensen duct in about half of bacterial cases [pus] - In newborns it can be quiet: fussiness and redness in front of the ear, no fever [redness] - Mumps swelling starts one-sided and turns bilateral in about nine of ten - Viral disease does not usually give pus from the duct - A stone may be felt in the duct or seen at its opening - Secondary infection: pain worsening, fever, and redness over the gland [fever · redness] - Tuberculous parotitis is a slow-growing, non-tender, one-sided swelling - Saliva flow drops, except where the cause is HIV, a metabolic one, or a tumour TESTS (10) - Look for pus at the Stensen duct and for a fluctuant gland - Check for facial nerve involvement, abscess, Lemierre syndrome or fistula - Massage the gland back to front to express pus for Gram stain and culture - Aspirate an abscess under ultrasound for microbiology - Examine ears, teeth and neck nodes for another source of infection - One-sided cystic swelling should prompt HIV testing - Stone diagnosis is mostly clinical: mealtime pain plus a stone felt or seen at the duct - High-resolution non-contrast CT is the preferred scan for stones - Ultrasound finds nine in ten stones over 2 mm but misses tumours and strictures - Ultrasound in juvenile recurrent parotitis shows patchy tissue with nodular hypoechoic areas IF NOT THIS - what else fits (12) - Salivary gland stone, a duct stricture, or a foreign body in the duct - Air in the gland from pneumoparotitis - Stensen duct squeezed from outside by dentures or a bulky masseter - Bacterial, viral or post-radiation sialadenitis - Gland inflammation after radioiodine or contrast dye, or caused by a drug - Bulimia nervosa - Melioidosis, or a salivary gland tumour - Sialosis from a metabolic cause - IgG4-related sialadenitis, Kussmaul disease or sarcoidosis - Granulomatosis with polyangiitis, including the eosinophilic form - HIV, amyloidosis, or spread to the parotid lymph nodes - Branchial cleft cyst, masseter hypertrophy, or Melkersson-Rosenthal syndrome Source StatPearls "Parotitis" - disease-level clinical article Status traced to the source above 1. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 875/125 mg orally twice daily (or 500/125 mg 3 times daily) with meals x 5 to 7 days for mild to moderate infection and 10 days for severe infection Peds 25-45 mg/kg/day [child max 1750 mg] (Child >3 months: 25-45 mg/kg/day divided BID based on amoxicillin component) 3kg -> 75-135 mg/day 4kg -> 100-180 mg/day 5kg -> 125-225 mg/day 6kg -> 150-270 mg/day 7kg -> 175-315 mg/day 8kg -> 200-360 mg/day 9kg -> 225-405 mg/day 10kg -> 250-450 mg/day 11kg -> 275-495 mg/day 12kg -> 300-540 mg/day 13kg -> 325-585 mg/day 14kg -> 350-630 mg/day 15kg -> 375-675 mg/day 16kg -> 400-720 mg/day 17kg -> 425-765 mg/day 18kg -> 450-810 mg/day 19kg -> 475-855 mg/day 20kg -> 500-900 mg/day 21kg -> 525-945 mg/day 22kg -> 550-990 mg/day 23kg -> 575-1035 mg/day 24kg -> 600-1080 mg/day 25kg -> 625-1125 mg/day 26kg -> 650-1170 mg/day 27kg -> 675-1215 mg/day 28kg -> 700-1260 mg/day 29kg -> 725-1305 mg/day 30kg -> 750-1350 mg/day 31kg -> 775-1395 mg/day 32kg -> 800-1440 mg/day 33kg -> 825-1485 mg/day 34kg -> 850-1530 mg/day 35kg -> 875-1575 mg/day 36kg -> 900-1620 mg/day 37kg -> 925-1665 mg/day 38kg -> 950-1710 mg/day 39kg -> 975-1750 mg/day (upper capped) 40kg -> 1000-1750 mg/day (upper capped) 41kg -> 1025-1750 mg/day (upper capped) 42kg -> 1050-1750 mg/day (upper capped) 43kg -> 1075-1750 mg/day (upper capped) 44kg -> 1100-1750 mg/day (upper capped) 45kg -> 1125-1750 mg/day (upper capped) 46kg -> 1150-1750 mg/day (upper capped) 47kg -> 1175-1750 mg/day (upper capped) 48kg -> 1200-1750 mg/day (upper capped) 49kg -> 1225-1750 mg/day (upper capped) 50kg -> 1250-1750 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 Why First-line oral antibiotic providing cover against S. aureus, S. pneumoniae, and oral anaerobes Caution Encourage sialogogues (lemon drops/sour candies), hydration, and gentle salivary gland massage. Contraindicated in penicillin hypersensitivity or history of co-amoxiclav jaundice. Refer urgently if fluctuation, abscess formation, or airway compromise develops. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) -> ? strength differs AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) -> ? strength differs E-MOXCLAV 375MG 10 F.C. TAB. EIPICO 20.40 EGP (2.04/unit) -> ? strength differs MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) -> ? strength differs CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) -> ? strength differs AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) -> ? strength differs CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP -> ? strength differs AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP -> ? strength differs LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 2. CLINDAMYCIN [2nd line] Adult 300-450 mg 4 times daily orally Peds 10-25 mg/kg/day [child max 1800 mg] (Child: 10-25 mg/kg/day divided TID-QID) 3kg -> 30-75 mg/day 4kg -> 40-100 mg/day 5kg -> 50-125 mg/day 6kg -> 60-150 mg/day 7kg -> 70-175 mg/day 8kg -> 80-200 mg/day 9kg -> 90-225 mg/day 10kg -> 100-250 mg/day 11kg -> 110-275 mg/day 12kg -> 120-300 mg/day 13kg -> 130-325 mg/day 14kg -> 140-350 mg/day 15kg -> 150-375 mg/day 16kg -> 160-400 mg/day 17kg -> 170-425 mg/day 18kg -> 180-450 mg/day 19kg -> 190-475 mg/day 20kg -> 200-500 mg/day 21kg -> 210-525 mg/day 22kg -> 220-550 mg/day 23kg -> 230-575 mg/day 24kg -> 240-600 mg/day 25kg -> 250-625 mg/day 26kg -> 260-650 mg/day 27kg -> 270-675 mg/day 28kg -> 280-700 mg/day 29kg -> 290-725 mg/day 30kg -> 300-750 mg/day 31kg -> 310-775 mg/day 32kg -> 320-800 mg/day 33kg -> 330-825 mg/day 34kg -> 340-850 mg/day 35kg -> 350-875 mg/day 36kg -> 360-900 mg/day 37kg -> 370-925 mg/day 38kg -> 380-950 mg/day 39kg -> 390-975 mg/day 40kg -> 400-1000 mg/day 41kg -> 410-1025 mg/day 42kg -> 420-1050 mg/day 43kg -> 430-1075 mg/day 44kg -> 440-1100 mg/day 45kg -> 450-1125 mg/day 46kg -> 460-1150 mg/day 47kg -> 470-1175 mg/day 48kg -> 480-1200 mg/day 49kg -> 490-1225 mg/day 50kg -> 500-1250 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph) Why Alternative for penicillin-allergic patients providing potent staphylococcal and anaerobic activity Caution Black box warning: there is a risk of Clostridioides difficile pseudomembranous colitis; stop if severe diarrhea occurs. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)