Epiglottitis medical therapy: Difference between revisions

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===Adjuvant Therapy===
===Adjuvant Therapy===


* Although adjuvant [[corticosteroids]] and racemic [[epinephrine]] are commonly used in the management of [[stridor]] associated with acute [[epiglottitis]], neither of them were proved effective in reducing the need of airway intervention or shortening the hospitalization.<ref name="pmid7933397">{{cite journal| author=Frantz TD, Rasgon BM, Quesenberry CP| title=Acute epiglottitis in adults. Analysis of 129 cases. | journal=JAMA | year= 1994 | volume= 272 | issue= 17 | pages= 1358-60 | pmid=7933397 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7933397  }} </ref>
* Although adjuvant [[corticosteroids]] and racemic [[epinephrine]] are commonly used in the management of [[stridor]] associated with acute [[epiglottitis]], neither of them were proved effective in reducing the need of airway intervention or shortening the hospitalization.<ref name="pmid7933397">{{cite journal| author=Frantz TD, Rasgon BM, Quesenberry CP| title=Acute epiglottitis in adults. Analysis of 129 cases. | journal=JAMA | year= 1994 | volume= 272 | issue= 17 | pages= 1358-60 | pmid=7933397 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7933397 }} </ref><ref name="pmid15983574">{{cite journal| author=Nickas BJ| title=A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy. | journal=J Emerg Nurs | year= 2005 | volume= 31 | issue= 3 | pages= 234-5; quiz 321 | pmid=15983574 | doi=10.1016/j.jen.2004.10.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15983574  }} </ref><ref name="pmid12557859">{{cite journal| author=Wick F, Ballmer PE, Haller A| title=Acute epiglottis in adults. | journal=Swiss Med Wkly | year= 2002 | volume= 132 | issue= 37-38 | pages= 541-7 | pmid=12557859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557859 }} </ref>


===Antimicrobial Regimens===
===Antimicrobial Regimens===

Revision as of 20:06, 17 January 2017

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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]

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. 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.[1][2]

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[7]
  • 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. 1.0 1.1 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 Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
  3. Kessler A, Wetmore RF, Marsh RR (1993). "Childhood epiglottitis in recent years". Int J Pediatr Otorhinolaryngol. 25 (1–3): 155–62. PMID 8436460.
  4. 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.
  5. 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.
  6. Frantz TD, Rasgon BM, Quesenberry CP (1994). "Acute epiglottitis in adults. Analysis of 129 cases". JAMA. 272 (17): 1358–60. PMID 7933397.
  7. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.