Usual causative organisms and antimicrobial regimens for suppurative parotitis in adults

Usual causative organisms	Initial parenteral antimicrobial regimens	Empiric oral step-down regimens
Community-acquired infection in immunocompetent patients
Staphylococcus aureus, viridans streptococci and other streptococci, Haemophilus influenzae, oral anaerobes (Peptostreptococci, Fusobacterium, etc)	Ampicillin-sulbactam 3 g IV every 6 hours Or Cefuroxime 1.5 g IV every 8 hours or Ceftriaxone 1 g every 24 hours or Levofloxacin 500 mg IV or orally every 24 hours^* Plus Metronidazole 500 mg IV or orally every 8 hours or Clindamycin 600 mg IV or orally every 6 to 8 hours If therapy against MRSA is indicated^¶, add one of the following to the above regimens: Vancomycin^Δ or Linezolid 600 mg IV or orally every 12 hours or Daptomycin 6 mg/kg IV every 24 hours	Amoxicillin-clavulanate 875/125 mg orally twice daily Or Cefuroxime 500 mg orally every 12 hours or Levofloxacin 500 mg orally every 24 hours^* Plus Metronidazole 500 mg orally every 8 hours Or Moxifloxacin 400 mg orally once daily^* If therapy against MRSA is indicated^◊, add one of the following to the above regimens: Linezolid 600 mg orally every 12 hours or Trimethoprim-sulfamethoxazole 1 double-strength tablet twice a day
Hospital-acquired infection or immunocompromised patients
Staphylococcus aureus (including MRSA), viridans streptococci and other streptococci, Haemophilus influenzae, Pseudomonas aeruginosa, Enterobacterales, oral anaerobes (eg, Peptostreptococci, Fusobacterium)	Vancomycin^Δ or Linezolid 600 mg IV or orally every 12 hours or Daptomycin 6 mg/kg every 24 hours Plus one of the following regimens: Cefepime 2 g IV every 12 hours plus metronidazole 500 mg IV or orally every 6 to 8 hours or Piperacillin-tazobactam 4.5 g IV every 6 hours or Imipenem 500 mg IV every 6 hours or Meropenem 1 g IV every 8 hours	Levofloxacin 750 mg orally every 24 hours plus metronidazole 500 mg orally every 8 hours Clindamycin 450 mg orally three times daily plus ciprofloxacin 750 mg orally twice daily^§ If therapy against MRSA is indicated^◊ and clindamycin cannot be used^§: Linezolid 600 mg IV or orally every 12 hours or Trimethoprim-sulfamethoxazole 1 double-strength tablet twice a day Plus Ciprofloxacin 750 mg orally twice daily or Levofloxacin 750 mg orally every 24 hours Plus Metronidazole 500 mg orally every 8 hours

The doses recommended in this table are intended for patients with normal renal and hepatic function.

ESBL: extended-spectrum-beta-lactamase; IV: intravenous; MRSA: methicillin-resistant Staphylococcus aureus.

* Fluoroquinolones should be reserved for patients who cannot tolerate or have contraindications to the beta-lactam regimens.

¶ Risk factors for MRSA infection include history of IV drug use, recent antibiotic use, recent surgery, residence in a long-term care facility, discharge from a hospital within the preceding 12 months, or hemodialysis. Immunocompromised patients or patients with a hospital-acquired infection are also at risk for MRSA.

Δ For severely ill patients, a vancomycin loading dose (20 to 35 mg/kg) is appropriate; within this range, we use a higher dose for critically ill patients. The loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. The initial maintenance dose and interval are determined by nomogram (typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function). Subsequent dose and interval adjustments are based on area under the curve-guided or trough-guided serum concentration monitoring. Refer to the UpToDate topic on vancomycin dosing for sample nomogram and discussion of vancomycin monitoring.

◊ MRSA therapy is indicated if MRSA was isolated on culture or as part of the initial empiric regimen in circumstances where no culture data is available and risk factors for MRSA are present. (Refer to ¶ footnote for list of MRSA risk factors).

§ MRSA susceptibility to clindamycin should be documented if this regimen is used for anti-MRSA therapy.

Graphic 60370 Version 18.0

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Usual causative organisms and antimicrobial regimens for suppurative parotitis in adults