Epiglottitis Treatment

• 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

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