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