A patient with a swollen and tender parotid gland following a Nissen fundoplication is suspected to have acute parotitis. What would be the most appropriate initial treatment?

The most appropriate initial treatment for acute parotitis, particularly in the context of a swollen and tender parotid gland following a Nissen fundoplication, is Augmentin. This medication is a combination of amoxicillin and clavulanate potassium, which provides good coverage against the common bacteria that can cause parotitis, including Staphylococcus aureus and certain anaerobes that might be present in the oral flora.

In the case of acute parotitis, especially post-surgical, bacterial infection is a frequent concern, and Augmentin's broad-spectrum antibiotic properties make it a strong first-line choice. It not only targets the typical pathogens involved but also addresses some resistant strains that might be problematic after a surgical procedure.

While other antibiotics might be effective in treating specific strains of bacteria, Augmentin’s efficacy against a wide variety of potential pathogens, including those associated with post-operative infections, makes it the most suitable option in this scenario. With parotitis, the choice of antibiotic should focus on appropriate initial coverage while also considering patient history and the potential for common bacteria encountered in such infections.