Dawaa Reference

Clinical reference

Salivary gland stone (sialolithiasis)

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

Evidence status

Checked against the sources named below

Sources6 sources

Anatomy, Head and Neck, Submandibular Gland - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK542272/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD66.03 - condition scope only, no dose · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Acute Sialadenitis - StatPearls - NCBI Bookshelf - disease-level clinical article (acute-sialadenitis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin.

Verified against5 documents
  • Salivary gland stone (sialolithiasis) - disease-level clinical article (sialolithiasis-clinical.txt)
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)
  • Acute Sialadenitis - StatPearls - NCBI Bookshelf - disease-level clinical article (acute-sialadenitis-full.txt)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

  • Swelling on one side of a salivary gland, felt as a neck lump, with sudden pain that gets worse while eating is the usual complaint [neck lump]

Signs — what you find (3)

  • The affected gland looks swollen compared to the other side on exam
  • A large stone may be visible in the mouth as an oval or round white-to-yellow object
  • A stone that is not visible can often still be felt along the path of the duct or gland

Tests (7)

  • Plain occlusal X-rays catch large stones but miss small ones, and only about 8 in 10 stones show up on X-ray at all
  • Injecting contrast into the duct for X-ray imaging is the traditional gold-standard test, though it carries radiation and contrast-reaction risk
  • A non-contrast CT scan detects calcified stones well and quickly, but shows the duct system poorly
  • Adding IV contrast to the CT gives a better look at the ducts and soft tissue with less overall radiation
  • MRI of the salivary ducts avoids radiation and contrast but is slower, costlier, and less available
  • Direct scope viewing of the duct gives an accurate diagnosis and can remove the stone at the same time
  • On ultrasound a stone looks like a bright spot with a shadow behind it, and detection is best for stones over 2 to 3 mm

If not this — what else fits (5)

  • Gland inflammation or infection without a stone can look the same as sialolithiasis
  • A tumor of the salivary gland is on the differential for gland swelling
  • Skin and soft-tissue infection of the face can mimic gland swelling
  • Dental decay leading to an abscess can present with similar facial swelling
  • Shingles affecting the face is included among conditions that can resemble this presentation

SourceStatPearls "Sialolithiasis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Pain | Antibiotic - only if the gland is infected | Main treatment

PAIN

1

IBUPROFEN

Pain

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - While the gland is painful and swelling with meals, alongside hydration, massage and sialogogues.

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Conservative management is the cornerstone of a salivary stone, and both articles put a non-steroidal anti-inflammatory drug in it: the stone article's conservative measures are gland massage, NSAIDs and sialogogues, and the sialadenitis article says NSAIDs are the appropriate analgesic and help decrease the inflammation. Neither names a drug or an amount, so the amount is MSF's.

Cautions
  • The pain that does not answer to it is a sign, not a dosing problem. The sialadenitis article says a patient in severe pain may require an opioid, and names no opioid and no amount, so none is printed.
  • The medicine does not move the stone. A mobile submandibular stone under 5 mm in the distal duct, one over 5 mm, or an impacted one, each has its own procedure and needs ENT or maxillofacial referral.
  • Anticholinergic medicines dry the saliva and work against the treatment; the sialadenitis article's conservative advice is to stop them where that is possible, along with staying well hydrated, warm compresses, duct massage and tart sweets such as lemon drops to drive salivary flow.
  • Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection.
  • Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication.
  • Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure.
  • It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

ANTIBIOTIC - ONLY IF THE GLAND IS INFECTED

2

CEPHALEXIN

Antibiotic - only if the gland is infected

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

250 to 1,000 mg every 6 hours, or 500 mg every 12 hours, to a maximum of 4 g a day. - The formulary sets no duration for a salivary gland infection. The sialadenitis article puts an uncomplicated case at 10 to 14 days of therapy in total.

Paediatric dose

25-50 mg/kg/day [child max 2000 mg]

(Child: 25 to 50 mg/kg a day for a mild to moderate infection, divided every 6 or 12 hours, to a maximum of 2,000 mg a day. The formulary's higher band of 75 to 100 mg/kg a day is for severe infection such as bone and joint infection, and is not what a salivary stone with a secondary infection calls for.)

Dose by weight
3kg75-150 mg/day
4kg100-200 mg/day
5kg125-250 mg/day
6kg150-300 mg/day
7kg175-350 mg/day
8kg200-400 mg/day
9kg225-450 mg/day
10kg250-500 mg/day
11kg275-550 mg/day
12kg300-600 mg/day
13kg325-650 mg/day
14kg350-700 mg/day
15kg375-750 mg/day
16kg400-800 mg/day
17kg425-850 mg/day
18kg450-900 mg/day
19kg475-950 mg/day
20kg500-1000 mg/day
21kg525-1050 mg/day
22kg550-1100 mg/day
23kg575-1150 mg/day
24kg600-1200 mg/day
25kg625-1250 mg/day
26kg650-1300 mg/day
27kg675-1350 mg/day
28kg700-1400 mg/day
29kg725-1450 mg/day
30kg750-1500 mg/day
31kg775-1550 mg/day
32kg800-1600 mg/day
33kg825-1650 mg/day
34kg850-1700 mg/day
35kg875-1750 mg/day
36kg900-1800 mg/day
37kg925-1850 mg/day
38kg950-1900 mg/day
39kg975-1950 mg/day
40kg1000-2000 mg/day
41kg1025-2000 mg/day (upper capped)
42kg1050-2000 mg/day (upper capped)
43kg1075-2000 mg/day (upper capped)
44kg1100-2000 mg/day (upper capped)
45kg1125-2000 mg/day (upper capped)
46kg1150-2000 mg/day (upper capped)
47kg1175-2000 mg/day (upper capped)
48kg1200-2000 mg/day (upper capped)
49kg1225-2000 mg/day (upper capped)
50kg1250-2000 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219) for the amount: usual adult oral range 250 to 1,000 mg every 6 hours or 500 mg every 12 hours, maximum 4 g/day; paediatric mild to moderate infection 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. The indication is the StatPearls acute sialadenitis article, whose sialolithiasis paragraph states that patients with a suspected secondary infection should receive dicloxacillin or cephalexin.

Why

A blocked salivary duct can infect behind the stone, and the stone article makes cervical adenopathy, purulent discharge from the duct, or erythema around the duct the trigger for antibiotic therapy without naming an agent. The sialadenitis article names the agents for exactly that situation, and cephalexin is the one of the two that Egypt stocks.

Cautions
  • Only when the gland is genuinely infected. The article's signs are cervical adenopathy, pus coming from the duct, or redness around the duct opening; without them the stone is treated with hydration, massage, sialogogues and an analgesic alone.
  • Dicloxacillin, the alternative the sialadenitis article names alongside cephalexin, has no product on the Egyptian register, so cephalexin is the workable one of the pair here.
  • Do not give it to anyone hypersensitive to cephalexin, to another cephalosporin, or to any component of the product.
  • Facial swelling with fever or pus points to suppurative infection, which the sialadenitis article treats as an inpatient problem needing intravenous antibiotics because of the risk of spread into the deep tissues of the head and neck.
  • Tablets and the oral suspension are not bioequivalent, so do not swap one for the other milligram for milligram.
Egyptian brands
Egyptian brandManufacturerIndicative price
CEFLODIX 500 MG 12 CAPS.ARAB CAPS > PHAROPHARMA9.00 EGP (0.75/unit)
CEPHALEXCID 500 MG 12 CAPS.CID10.30 EGP (0.86/unit)
CEPHOXIN 500MG 12 TAB.PHARCO B10.50 EGP (0.88/unit)
CEPHALEXIN 500MG 10 CAPS.ARAB DRUG COMPANY (ADCO)10.10 EGP (1.01/unit)
MEDICEFLEXIN 500 MG 20 CAPS.T3A PHARMA > RIVA PHARMA S.A.E.25.25 EGP (1.26/unit)
CEPHALEXIN 500MG 12 CAPS B.P.2007SHIFA MEDICAL PRODUCTS > OCTOBER PHARMA27.00 EGP (2.25/unit)
KEFLEX 500 MG 12 CAPS.HIKMA PHARMA58.00 EGP (4.83/unit)
CEPOREX 500MG 12 TABS.GLAXO SMITHKLINE69.00 EGP (5.75/unit)
AMTHROST 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.00 EGP
AMTHROST 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.50 EGP

MAIN TREATMENT

3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

A calcified stone blocking a salivary duct (usually submandibular) causes painful swelling that worsens with eating. GP advises hydration, sialogogues (e.g. sour sweets), gland massage, and analgesia; gives antibiotics if the gland is infected; refers to ENT/maxillofacial for stone removal if it does not resolve. - Refer, with advice

Paediatric dose

A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A calcified stone blocking a salivary duct (usually submandibular) causes painful swelling that worsens with eating. GP advises hydration, sialogogues (e.g. sour sweets), gland massage, and analgesia; gives antibiotics if the gland is infected; refers to ENT/maxillofacial for stone removal if it does not resolve.

Cautions
  • The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.
  • RED FLAG - THE SIGNS THAT MEAN THE GLAND IS INFECTED AND NEEDS AN ANTIBIOTIC: enlarged neck nodes, pus coming from the duct opening, and redness of the skin around the duct. A stone alone does not need an antibiotic; a stone with these does.
  • RED FLAG - Complications of chronic untreated obstruction include permanent gland fibrosis and atrophy.
  • RED FLAG - Facial swelling with fever or pus, suggesting suppurative sialadenitis, signs of abscess, or recurrent stones.

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