Epiglottitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2] Prince Tano Djan, BSc, MBChB [3]

Overview

Epiglottitis is a medical emergency and warrants immediate establishment of a patent airway. Once the airway has been secured, cultures of blood and epiglottic surface should be obtained before administration of antimicrobial therapy. Administering high-flow oxygen, establishing intravenous access, and calling the ENT specialist are standard first-line interventions for epiglottitis.[1] An appropriate antibiotic regimen that covers Streptococcus pneumoniae, beta-hemolytic streptococci, and Staphylococcus aureus includes parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin (or Levofloxacin in combination with Clindamycin for Penicillin-allergic patients). Adjuvant therapy is commonly used in the management of stridor associated with acute epiglottitis. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[2][3]

Principles of Therapy for Acute Epiglottitis

Antibiotic Therapy

  • The optimal duration of antimicrobial therapy is yet to be determined. Acute epiglottitis usually responds to a 7– to 10–day course of intravenous antibiotics.

Adjuvant Therapy

Antimicrobial Regimens

  • Epiglottitis[8]
  • 1. Empiric antimicrobial therapy
  • 1.1 Pediatrics
  • 1.2 Adults
  • 2. Pathogen-directed antimicrobial therapy
  • 2.1 Streptococcus pneumoniae
  • 2.2 Streptococcus pyogenes
  • 2.3 Streptococcus agalactiae
  • 2.4 Streptococcus anginosus
  • 2.5 Methicillin-sensitive Staphylococcus aureus
  • 2.6 Methicillin-resistant Staphylococcus aureus
  • 2.7 Haemophilus influenzae
  • 2.8 Klebsiella pneumoniae
  • 2.9 Moraxella catarrhalis
  • 2.10 Neisseria meningitidis
  • 2.11 Neisseria gonorrhoeae
  • 2.12 Pasteurella multocida
  • 2.13 Pseudomonas aeruginosa
  • 2.14 Candida albicans

References

  1. Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
  2. 2.0 2.1 Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
  3. 3.0 3.1 Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
  4. Kessler A, Wetmore RF, Marsh RR (1993). "Childhood epiglottitis in recent years". Int J Pediatr Otorhinolaryngol. 25 (1–3): 155–62. PMID 8436460.
  5. Alcaide ML, Bisno AL (2007). "Pharyngitis and epiglottitis". Infect Dis Clin North Am. 21 (2): 449–69, vii. doi:10.1016/j.idc.2007.03.001. PMID 17561078.
  6. Loftis L (2006). "Acute infectious upper airway obstructions in children". Semin Pediatr Infect Dis. 17 (1): 5–10. doi:10.1053/j.spid.2005.11.003. PMID 16522499.
  7. Frantz TD, Rasgon BM, Quesenberry CP (1994). "Acute epiglottitis in adults. Analysis of 129 cases". JAMA. 272 (17): 1358–60. PMID 7933397.
  8. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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