Epiglottitis medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Bot: Removing from Primary care)
 
(67 intermediate revisions by 11 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Epiglottitis}}
{{Epiglottitis}}
{{CMG}}; {{AE}} {{Alonso}} {{PTD}}


{{CMG}}
==Overview==


==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.<ref name="pmid159835742">{{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>  An appropriate antibiotic regimen that covers ''[[Streptococcus pneumoniae]]'', [[hemolysis|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]].<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>
 
==Principles of Therapy for Acute Epiglottitis==
 
===Antibiotic Therapy===
 
* In view of the emergence of ''[[Streptococcus pneumoniae]]'', [[hemolysis|beta-hemolytic]] [[streptococci]], and [[ampicillin]]-resistant ''[[Haemophilus influenzae]]'' as the most common causative bacteria of acute epiglottitis, empiric therapy with a third-generation [[cephalosporin]] (such as [[cefotaxime]] and [[ceftriaxone]]) or [[ampicillin sulbactam|ampicillin-sulbactam]] is recommended.<ref name="pmid8436460">{{cite journal| author=Kessler A, Wetmore RF, Marsh RR| title=Childhood epiglottitis in recent years. | journal=Int J Pediatr Otorhinolaryngol | year= 1993 | volume= 25 | issue= 1-3 | pages= 155-62 | pmid=8436460 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8436460  }} </ref>
 
* An anti-[[Staphylococcus aureus|staphylococcal]] agent (such as [[vancomycin]] or [[clindamycin]]) should be added to the initial treatment in areas with increased [[prevalence]] of [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]] or [[penicillin]]-resistant [[pneumococci]].<ref name="pmid17561078">{{cite journal| author=Alcaide ML, Bisno AL| title=Pharyngitis and epiglottitis. | journal=Infect Dis Clin North Am | year= 2007 | volume= 21 | issue= 2 | pages= 449-69, vii | pmid=17561078 | doi=10.1016/j.idc.2007.03.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17561078  }} </ref><ref name="pmid16522499">{{cite journal| author=Loftis L| title=Acute infectious upper airway obstructions in children. | journal=Semin Pediatr Infect Dis | year= 2006 | volume= 17 | issue= 1 | pages= 5-10 | pmid=16522499 | doi=10.1053/j.spid.2005.11.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16522499  }} </ref>
 
* 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]].


==Medical Therapy==
===Adjuvant Therapy===


Patients should be given an [[antibiotic]] [[medication|drug]] such as [[ceftriaxone]] or chloramphenicol either alone or in association with penicillin or ampicillin for streptococcal coverage.
* 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>


Other [[treatments]] may include:
===Antimicrobial Regimens===
*[[Anti-inflammatory]] medicines called [[corticosteroids]] to decrease [[throat]] [[swelling]]
*'''Epiglottitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
*[[Fluids]] given through a [[vein]] (by [[IV]])
:*'''1. Empiric antimicrobial therapy'''
::*'''1.1 Pediatrics'''
:::*Preferred regimen (1): [[Cefotaxime]] 50 mg/kg IV q8h
:::*Preferred regimen (2): [[Ceftriaxone]] 50–75 mg/kg/day IV q12–24h {{and}} [[Vancomycin]] 10 mg/kg IV q6h
:::*Alternate regimen (1): [[Levofloxacin]] 500 mg IV q24h (or 8 mg/kg IV q12h) {{and}} [[Clindamycin]] 20–40 mg/kg/day IV q6–8h
::*'''1.2 Adults'''
:::*Preferred regimen (1): [[Cefotaxime]] 2 g IV q4–8h
:::*Preferred regimen (2): [[Ceftriaxone]] 1–2 g/day IV q12–24h {{and}} [[Vancomycin]] 2 g/day IV q6–12h
:::*Alternate regimen (1): [[Levofloxacin]] 750 mg IV q24h {{and}} [[Clindamycin]] 600–1200 mg IV q6–12h
:*'''2. Pathogen-directed antimicrobial therapy'''
::*'''2.1 Streptococcus pneumoniae'''
:::*Preferred regimen: [[Penicillin G]] 2 MU IV q4h {{or}} [[Ceftriaxone]] 2 g IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h
:::*Alternative regimen: [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Vancomycin]] 1 g IV q12h {{or}} [[Linezolid]] 600 mg IV q12h {{or}} [[Ceftaroline]] 600 mg IV q12h
::*'''2.2 Streptococcus pyogenes'''
:::*Preferred regimen: ([[Penicillin G]] 1.2 MU IV single dose {{then}} [[Penicillin VK]] 500 mg PO q12h) {{or}} [[Amoxicillin]] 500 mg PO q12h
:::*Alternative regimen: [[Clindamycin]] 300 mg PO q8h {{or}} [[Azithromycin]] 500 mg PO q24h {{or}} [[Cephalexin]] 500 mg PO q12h
::*'''2.3 Streptococcus agalactiae'''
:::*Preferred regimen: [[Penicillin G]] 2 MU IV q4h
:::*Alternative regimen: [[Vancomycin]] 20 mg/kg IV q8h {{or}} [[Clindamycin]] 600 mg IV q6h
::*'''2.4 Streptococcus anginosus'''
:::*Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Ceftriaxone]] 2 g IV q24h
:::*Alternative regimen: [[Vancomycin]] 1 g IV q12h {{or}} [[Clindamycin]] 600 mg IV q6h
::*'''2.5 Methicillin-sensitive Staphylococcus aureus'''
:::*Preferred regimen: [[Nafcillin]] 2 g IV q4-6h {{or}} [[Oxacillin]] 2 mg IV q4-6h {{or}} Cefazolin 2 g IV q8h
:::*Alternative regimen: [[Dicloxacillin]] 500 mg PO q6h {{or}} [[Cephalexin]] 500 mg PO q6h {{or}} [[Clindamycin]] 300 mg PO q6h {{or}} [[Clindamycin]] 300 mg PO q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 160/800 mg PO q12h
::*'''2.6 Methicillin-resistant Staphylococcus aureus'''
:::*Preferred regimen: [[Vancomycin]] 15-20 mg/kg IV q8-12h {{or}} [[Daptomycin]] 4-6 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV q12h
:::*Alternative regimen: [[Linezolid]] 600 mg/kg IV q12h {{or}} [[Daptomycin]] 4-6 mg/kg IV q24h {{or}} [[Ceftaroline]] 600 mg IV q8h
::*'''2.7 Haemophilus influenzae'''
:::*Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q8h
:::*Alternative regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q8h
::*'''2.8 Klebsiella pneumoniae'''
:::*Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q8h {{or}} [[Levofloxacin]] 750 mg IV q24h
:::*Alternative regimen: [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Ertapenem]] 1 g IV q24h
::*'''2.9 Moraxella catarrhalis'''
:::*Preferred regimen: [[Amoxicillin-clavulanate]] 850/125 mg PO q24h
:::*Alternative regimen: ([[Azithromycin]] 500 mg PO q24h first day {{then}} 250 mg PO q24h) {{or}} [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg IV q6—12h
::*'''2.10 Neisseria meningitidis'''
:::*Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q6h
:::*Alternative regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Chloramphenicol]] 100 mg/kg/day q6h (maximum dose 4 g/day)
::*'''2.11 Neisseria gonorrhoeae'''
:::*Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q6h
:::*Alternative regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Chloramphenicol]] 100 mg/kg/day q6h (maximum dose 4 g/day)
::*'''2.12 Pasteurella multocida'''
:::*Preferred regimen: [[Penicillin VK]] 500 mg PO q12h {{or}} [[Amoxicillin]] 500 mg PO q8h {{or}} [[Amoxicillin-clavulanate]] 850/125 mg PO q12h
:::*Alternative regimen: [[Cefuroxime]] 500 mg PO q12h {{or}} [[Levofloxacin]] 750 mg PO q24h {{or}} [[Moxifloxacin]] 400 mg PO q24h {{or}} [[Doxycycline]] 100 mg PO q12h
::*'''2.13 Pseudomonas aeruginosa'''
:::*Preferred regimen: ([[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q8h) {{and}} ([[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg PO q24h)
::*'''2.14 Candida albicans'''
:::*Preferred regimen: ([[Fluconazole]] 200 mg IV q24h for 14 days {{or}} [[Fluconazole]] 200 mg PO q24h for 14 days) {{and}} [[Nystatin]] oral suspension PO q6h for 14 days
:::*Alternative regimen:  [[Itraconazole]] solution 200 mg PO q24h for 14 days {{or}} ([[Amphotericin B]] 0.3 mg/kg PO q12h 3 days {{then}} q24h for 14 days) {{or}} [[Caspofungin]] PO q6h for 14 days


==References==
==References==
{{Reflist|2}}
 
{{reflist|2}}
 
[[Category:Bacterial diseases]]
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Laryngology]]
[[Category:Medical emergencies]]
[[Category:Otolaryngology]]
[[Category:Pediatrics]]
[[Category:Pulmonology]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]

Latest revision as of 21:36, 29 July 2020

Epiglottitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Epiglottitis from other Diseases

Epidemiology and Demographics

Screening

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Rays

ECG

CT scan

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Epiglottitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Epiglottitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Epiglottitis medical therapy

CDC on Epiglottitis medical therapy

Epiglottitis medical therapy in the news

Blogs on Epiglottitis medical therapy

Directions to Hospitals Treating Epiglottitis

Risk calculators and risk factors for Epiglottitis medical therapy

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.