Management of Post-Extraction Parotitis

Immediate Management

The American College of Surgeons recommends immediate hospital admission with IV antibiotics if there is airway compromise, inability to maintain oral hydration, signs of necrotizing fasciitis, or sepsis 1, 2, 3
Surgical drainage is mandatory and must precede antibiotic therapy, as antibiotics without adequate surgical drainage guarantee treatment failure 1, 2
The first-line antibiotic regimen is amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days, which provides coverage for both S. aureus and oral anaerobes 1, 2
For penicillin allergy, clindamycin 300-400 mg orally three times daily for 5-7 days is recommended, providing excellent coverage for both gram-positive cocci and anaerobes 1, 2

Meticulous oral hygiene with chlorhexidine 0.12% mouth rinse twice daily is recommended 4
Aggressive hydration to maintain salivary flow, sialagogues to promote parotid drainage, and warm compresses to the affected area are also recommended [[ignore ref], but implied by 4]

Maintaining excellent oral hygiene before and after extraction, ensuring adequate hydration in the post-operative period, and considering chlorhexidine mouth rinse starting pre-operatively and continuing 7-10 days post-extraction are recommended 3, 4, 5
Routine antibiotic prophylaxis is NOT recommended for simple extractions in healthy patients 2