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Acute Parotitis S. aureus Treatment — ORE Part 1 MCQ

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HardOral SurgeryAcute Parotitis S. aureus TreatmentORE Part 1

An adult presents with a 2-week history of rapidly developing painful swelling over the parotid gland. The gland is warm and tender, the patient is febrile, and pus can be expressed from Stensen’s duct. Blood cultures grow Staphylococcus aureus susceptible to flucloxacillin. What is the most appropriate initial management?

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Correct answer: C — Admit for intravenous flucloxacillin, hydration and salivary-flow measures; drain if an abscess is identified

This is acute bacterial suppurative parotitis with systemic infection: fever, purulent duct discharge and S. aureus bacteraemia indicate severe disease requiring admission and intravenous antistaphylococcal therapy. Flucloxacillin is appropriate when the isolate is susceptible; hydration and measures that promote salivary flow help correct salivary stasis. Imaging should be used if abscess is suspected, with drainage where a collection is present or treatment fails. Oral amoxicillin is unsuitable because it is unreliable against penicillinase-producing S. aureus and is inadequate initial treatment in this severe presentation. Parotidectomy and radiotherapy do not treat acute suppurative infection. Observation risks progression of sepsis and local complications.

Reference: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust. Respiratory Tract Infections antimicrobial policy: Acute bacterial parotitis, 2023. https://www.dbth.nhs.uk/wp-content/uploads/2023/03/Policy-for-the-Treatment-of-URTI-2023-extension.pdf