epiglottitis
EPIGLOTTITIS
Epiglottitis is the inflammation of the epiglottis and supraglottic tissues (aryepilottic folds, arytenoid, uvula).
It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children requiring immediate treatment and typically artificial airway placement.
H. influenzae type B is the most common etiologic agent in children.

Epiglottitis Treatment

Pharmacotherapy

  • Empiric treatment w/ antibiotics effective against H influenzae should be started pending results of culture & sensitivity studies
    • The prevalence of beta-lactamase producing organisms, together w/ local antimicrobial resistance patterns, should be taken into consideration when choosing an antibiotic

Penicillins

  • Eg Ampicillin/Sulbactam, Piperacillin/Tazobactam, Amoxicillin/Clavulanic Acid
  • Ampicillin alone is not recommended in settings w/ a high prevalence of beta-lactamase producing organisms
  • Piperacillin/Tazobactam combination is recommended for immunocompromised patients due to its wide coverage

3rd Generation Cephalosporins (Parenteral)

  • Eg Cefotaxime, Ceftriaxone
  • Employed empirically because of the increasing frequency of beta-lactamase producing organisms

Co-trimoxazole

  • May be used as an alternative in patients w/ type 1 allergy to Penicillin

Fluoroquinolone

  • Eg Levofloxacin, Moxifloxacin
  • Treatment option for patients allergic to beta-lactamase inhibitors
  • Not recommended for children <16 years of age

Antibacterial Combinations

  • Eg Trimethoprim/Sulfamethoxazole
  • Treatment option for patients allergic to beta-lactamase inhibitors

Other Antibiotics

  • Eg Vancomycin, Clindamycin
  • Vancomycin is recommended for patients at high risk for penicillin-resistant diseases
  • Clindamycin combined w/ a fluoroquinolone is another treatment option for patients allergic to beta-lactamase inhibitors

Duration of Therapy

  • Antibiotics should be given for 7-10 days

Other Pharmacologic Agents

  • Racemic Epinephrine & corticosteroids are not effective

Non-Pharmacological Therapy

Patient/Guardian Reassurance

  • Actions that minimize anxiety & pain are appropriate until the airway is secure
  • Child should be held & comforted
  • Avoid anxiety-provoking maneuvers [eg blood extraction, intravenous (IV) line placement, placing the child in a supine position or direct inspection of the oral cavity] until the airway is secure

Oxygen Therapy

  • Provide supplemental oxygen (O2) if necessary
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
05 Feb 2021

Primary immunodeficiency disease (PIDD) and allergies are two groups of conditions related to the immune system. However, they are uniquely different in terms of symptoms and treatment.

Roshini Claire Anthony, 24 Feb 2021

Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) did not result in worsening renal function or bone mineral density (BMD) in Asian patients with chronic hepatitis B virus (HBV) infection, according to a small real-world prospective study.

Roshini Claire Anthony, 6 days ago

Critical or severe COVID-19 disease could raise the risk of negative perinatal outcomes in pregnant women, according to an observational study from the US.

Stephen Padilla, 22 Feb 2021
Treatment with intravenous (IV) dexamethasone for 10 days significantly reduces duration of mechanical ventilation at 28 days and 60-day mortality in patients with established moderate-to-severe acute respiratory disease syndrome (ARDS) compared with no dexamethasone, results of the DEXA-ARDS trial have shown.