eMedicine Specialties > Emergency Medicine > Infectious Diseases

Mumps: Treatment & Medication

Author: Kristin A Carmody, MD, Assistant Professor, Boston University Medical School; Attending Physician, Department of Emergency Medicine and Associate Director of Emergency Ultrasound, Boston Medical Center
Coauthor(s): Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Mar 23, 2009

Treatment

Prehospital Care

  • Supportive care is usually all that is needed for patients with mumps.
  • Persons exposed to the virus should be counseled on vaccination and risks.

Emergency Department Care

  • Supportive care and outpatient follow up is indicated for straightforward infections.
  • Complications due to mumps should be treated based on presentation.
    • Testicular ultrasonography for orchitis
    • Ice packs applied to scrotal area for swelling
    • Discharge with scrotal support and anti-inflammatory agents
    • Intravenous hydration for severe pancreatitis
    • Lumbar puncture for symptomatic meningitis or encephalitis

Consultations

Consultations should be requested as needed for specific complications.

Medication

Treatment of bacterial parotitis should be directed against S aureus.

Antibiotics

For suppurative parotitis when S aureus is the pathogen.


Amoxicillin and clavulanate (Augmentin)

Drug combination treats bacteria resistant to beta-lactam antibiotics.

Adult

500 mg PO q12h or 250 mg PO q8h

Pediatric

45 mg/kg/d PO divided bid/tid; not to exceed 750-1500 mg/d
Children >3 months: Base dosing protocol on amoxicillin content; due to different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable tab (250/62.5), do not use 250-mg tab until child weighs >40 kg

Coadministration with warfarin or heparin increases risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Give for a minimum of 10 d to eliminate organism and prevent sequelae (endocarditis, and rheumatic fever); following treatment, perform cultures to confirm eradication of streptococci


Cefadroxil (Duricef)

First generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Used for skin and soft tissue infections caused by S aureus.

Adult

1-2 g/d PO divided bid

Pediatric

30 mg/kg PO divided bid; not to exceed 2 g/d

Probenecid may decrease clearance of cephalosporins; aminoglycosides and furosemide may decrease nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe renal impairment; prolonged use may result in superinfection


Clindamycin (Cleocin)

Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest.

Adult

150-450 mg/dose PO q6-8h; not to exceed 1.8 g/d

Pediatric

8-20 mg/kg/d PO as hydrochloride or 8-25 mg/kg/d as palmitate divided tid/qid

Increases duration of neuromuscular blockade, induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin

Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic associated colitis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile

More on Mumps

Overview: Mumps
Differential Diagnoses & Workup: Mumps
Treatment & Medication: Mumps
Follow-up: Mumps
References
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References

  1. Caplan CE. Mumps in the era of vaccines. CMAJ. Mar 23 1999;160(6):865-6. [Medline].

  2. Recommended adult immunization schedule - United States, 2009. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?doc_id=13982&nbr=007058&string=mumps. Accessed March 23, 2009.

  3. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?doc_id=12325&nbr=006390&string=mumps. Accessed March 23, 2009.

  4. Global status of mumps immunization and surveillance. Wkly Epidemiol Rec. Dec 2 2005;80(48):418-24. [Medline].

  5. CDC; MMWR Weekly. Mumps Epidemic - Iowa, 2006. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a3.htm. Accessed September 29, 2008.

  6. Majda-Stanislawska E. Mumps cerebellitis. Eur Neurol. 2000;43(2):117. [Medline].

  7. Nussinovitch M, Volovitz B, Varsano I. Complications of mumps requiring hospitalization in children. Eur J Pediatr. Sep 1995;154(9):732-4. [Medline].

  8. Saijo M, Fujita K. [Central nervous system infection caused by mumps virus]. Nippon Rinsho. Apr 1997;55(4):870-5. [Medline].

  9. Sonmez FM, Odemis E, Ahmetoglu A, Ayvaz A. Brainstem encephalitis and acute disseminated encephalomyelitis following mumps. Pediatr Neurol. Feb 2004;30(2):132-4. [Medline].

  10. Wharton IP, Chaudhry AH, French ME. A case of mumps epididymitis. Lancet. Feb 25 2006;367(9511):702. [Medline].

  11. Kayan A, Bellman H. Bilateral sensorineural hearing loss due to mumps. Br J Clin Pract. Dec 1990;44(12):757-9. [Medline].

  12. McQuone SJ. Acute viral and bacterial infections of the salivary glands. Otolaryngol Clin North Am. Oct 1999;32(5):793-811. [Medline].

  13. Kabakus N, Aydinoglu H, Yekeler H. Fatal mumps nephritis and myocarditis. J Trop Pediatr. Dec 1999;45(6):358-60. [Medline].

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Further Reading

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Keywords

mumps, mumps virus, mumps vaccine, parotitis, swollen cheeks, epidemic parotiditis, measles-mumps-rubella vaccine, MMR vaccine, vaccination, shots, paramyxovirus, meningitis, CNS involvement in mumps, orchitis, deafness, pancreatitis

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Contributor Information and Disclosures

Author

Kristin A Carmody, MD, Assistant Professor, Boston University Medical School; Attending Physician, Department of Emergency Medicine and Associate Director of Emergency Ultrasound, Boston Medical Center
Kristin A Carmody, MD is a member of the following medical societies: American College of Emergency Physicians, American Institute of Ultrasound in Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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