epiglottitis
EPIGLOTTITIS
Treatment Guideline Chart
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
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