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
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