Dawaa Reference

infectious

Acute suppurative sialadenitis (parotitis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

IDSA Guidelines · Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph)

Verified against1 document
  • Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Parotitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

AMOXICILLIN + CLAVULANIC ACID

1st line

Strength875 mg

Formoral.solid

Adult dose and duration

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

Paediatric dose

25-45 mg/kg/day [child max 1750 mg]

(Child >3 months: 25-45 mg/kg/day divided BID based on amoxicillin component)

Dose by weight
3kg75-135 mg/day
4kg100-180 mg/day
5kg125-225 mg/day
6kg150-270 mg/day
7kg175-315 mg/day
8kg200-360 mg/day
9kg225-405 mg/day
10kg250-450 mg/day
11kg275-495 mg/day
12kg300-540 mg/day
13kg325-585 mg/day
14kg350-630 mg/day
15kg375-675 mg/day
16kg400-720 mg/day
17kg425-765 mg/day
18kg450-810 mg/day
19kg475-855 mg/day
20kg500-900 mg/day
21kg525-945 mg/day
22kg550-990 mg/day
23kg575-1035 mg/day
24kg600-1080 mg/day
25kg625-1125 mg/day
26kg650-1170 mg/day
27kg675-1215 mg/day
28kg700-1260 mg/day
29kg725-1305 mg/day
30kg750-1350 mg/day
31kg775-1395 mg/day
32kg800-1440 mg/day
33kg825-1485 mg/day
34kg850-1530 mg/day
35kg875-1575 mg/day
36kg900-1620 mg/day
37kg925-1665 mg/day
38kg950-1710 mg/day
39kg975-1750 mg/day (upper capped)
40kg1000-1750 mg/day (upper capped)
41kg1025-1750 mg/day (upper capped)
42kg1050-1750 mg/day (upper capped)
43kg1075-1750 mg/day (upper capped)
44kg1100-1750 mg/day (upper capped)
45kg1125-1750 mg/day (upper capped)
46kg1150-1750 mg/day (upper capped)
47kg1175-1750 mg/day (upper capped)
48kg1200-1750 mg/day (upper capped)
49kg1225-1750 mg/day (upper capped)
50kg1250-1750 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

First-line oral antibiotic providing cover against S. aureus, S. pneumoniae, and oral anaerobes

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.? strength differsEIPICO14.00 EGP (1.40/unit)
AUJED 625 MG 12 F.C. TAB.? strength differsSIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS19.20 EGP (1.60/unit)
E-MOXCLAV 375MG 10 F.C. TAB.? strength differsEIPICO20.40 EGP (2.04/unit)
MAGNABIOTIC 625MG 8 TAB.? strength differsSEDICO37.00 EGP (4.62/unit)
CURAM 625MG 12 F.C.TAB.? strength differsSANDOZ > NOVARTIS108.00 EGP (9.00/unit)
AUGMENTIN 625 MG 10 F.C.TABS.? strength differsMUP > SMITHKLINE BEECHAM117.00 EGP (11.70/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.? strength differsRAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS? strength differsGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP
2

CLINDAMYCIN

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

300-450 mg 4 times daily orally

Paediatric dose

10-25 mg/kg/day [child max 1800 mg]

(Child: 10-25 mg/kg/day divided TID-QID)

Dose by weight
3kg30-75 mg/day
4kg40-100 mg/day
5kg50-125 mg/day
6kg60-150 mg/day
7kg70-175 mg/day
8kg80-200 mg/day
9kg90-225 mg/day
10kg100-250 mg/day
11kg110-275 mg/day
12kg120-300 mg/day
13kg130-325 mg/day
14kg140-350 mg/day
15kg150-375 mg/day
16kg160-400 mg/day
17kg170-425 mg/day
18kg180-450 mg/day
19kg190-475 mg/day
20kg200-500 mg/day
21kg210-525 mg/day
22kg220-550 mg/day
23kg230-575 mg/day
24kg240-600 mg/day
25kg250-625 mg/day
26kg260-650 mg/day
27kg270-675 mg/day
28kg280-700 mg/day
29kg290-725 mg/day
30kg300-750 mg/day
31kg310-775 mg/day
32kg320-800 mg/day
33kg330-825 mg/day
34kg340-850 mg/day
35kg350-875 mg/day
36kg360-900 mg/day
37kg370-925 mg/day
38kg380-950 mg/day
39kg390-975 mg/day
40kg400-1000 mg/day
41kg410-1025 mg/day
42kg420-1050 mg/day
43kg430-1075 mg/day
44kg440-1100 mg/day
45kg450-1125 mg/day
46kg460-1150 mg/day
47kg470-1175 mg/day
48kg480-1200 mg/day
49kg490-1225 mg/day
50kg500-1250 mg/day
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (clindamycin monograph)

Why

Alternative for penicillin-allergic patients providing potent staphylococcal and anaerobic activity

Cautions
  • Black box warning: there is a risk of Clostridioides difficile pseudomembranous colitis; stop if severe diarrhea occurs.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.