{ "schema_version": 1, "kind": "condition", "id": "sialolithiasis", "name": "Salivary gland stone (sialolithiasis)", "category": "chronic", "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.", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 1693, "generic": "Ibuprofen", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "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.", "adult_duration": "While the gland is painful and swelling with meals, alongside hydration, massage and sialogogues.", "dose_source": "MSF Essential Drugs 2024 (ibuprofen oral monograph)", "rationale": "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." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 10.0, "peds_max_mg": 400.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 300, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 400, "capped": false } ], "brands": [ { "trade_name": "DAJUANOFEN 400 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "COPAD PHARMA", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLABU 400MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 3.75, "pack_count": 10, "unit_price": 0.38, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 400MG 30 F.C. TABLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.75, "pack_count": 30, "unit_price": 0.42, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUPROFEN 400 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 6.0, "pack_count": 10, "unit_price": 0.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAFO 400 MG 30 F.C.TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEN 400 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 78.0, "pack_count": 30, "unit_price": 2.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROFUSOL 400MG 20 S.G CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANALGIPROF 400 MG 25 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 37.5, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "sialolithiasis" }, { "id": 1694, "generic": "Cephalexin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "250 to 1,000 mg every 6 hours, or 500 mg every 12 hours, to a maximum of 4 g a day.", "adult_duration": "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.", "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.", "rationale": "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." ], "peds_mgkg_low": 25.0, "peds_mgkg_high": 50.0, "peds_max_mg": 2000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 250, "high_mg": 500, "capped": false }, { "weight_kg": 20, "low_mg": 500, "high_mg": 1000, "capped": false }, { "weight_kg": 30, "low_mg": 750, "high_mg": 1500, "capped": false }, { "weight_kg": 40, "low_mg": 1000, "high_mg": 2000, "capped": false } ], "brands": [ { "trade_name": "CEFLODIX 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS > PHAROPHARMA", "price_egp": 9.0, "pack_count": 12, "unit_price": 0.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXCID 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 10.3, "pack_count": 12, "unit_price": 0.86, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHOXIN 500MG 12 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 10.5, "pack_count": 12, "unit_price": 0.88, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXIN 500MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 10.1, "pack_count": 10, "unit_price": 1.01, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEDICEFLEXIN 500 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "T3A PHARMA > RIVA PHARMA S.A.E.", "price_egp": 25.25, "pack_count": 20, "unit_price": 1.26, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXIN 500MG 12 CAPS B.P.2007", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SHIFA MEDICAL PRODUCTS > OCTOBER PHARMA", "price_egp": 27.0, "pack_count": 12, "unit_price": 2.25, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KEFLEX 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 58.0, "pack_count": 12, "unit_price": 4.83, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPOREX 500MG 12 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 69.0, "pack_count": 12, "unit_price": 5.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMTHROST 125MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SABAA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "AMTHROST 250MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SABAA", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "sialolithiasis" }, { "id": 1695, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "sialolithiasis" } ] }