Epiglottitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Patients should receive empiric antibiotic treatment after sample for throat culture has been taken. The recomended treatment is a combination of a third generation cephaplosporin such as ceftriaxone or cefotaxime with an antistaphylococcal agent, active against. If MRSA is not considered as a possible cause for the infection, ceftriaxone, cefotaxime or amplicilin/sulbactam IV monotherapy could be cosidered.

Empiric Therapy

Pediatric patient Preferred Regimen ▸ Vancomycin 10 mg/kg per dose IV q4h PLUS ▸ Ceftriaxone 50-75 mg/kg administered IV q24h OR Cefotaxime 50 mg/kg IV q8h Alternative Regimen (If Allergic to Penicillin) ▸ Clindamycin 7.5 mg/kg mg IV q6h PLUS ▸ Levofloxacin 100 mg/kg IV q24h Adult patient Preferred Regimen ▸ Vancomycin 1 g IV q12h PLUS ▸ Ceftriaxone 2 g IV q24h OR Cefotaxime 2 g IV q8h Alternative Regimen (If Allergic to Penicillin) ▸ Clindamycin 600-900 mg IV q6h PLUS ▸ Levofloxacin 750 mg IV q24h Pathogen based theerapy ▸ Click on the following categories to expand treatment regimens. Bacteria   ▸  Streptococcus pneumoniae   ▸  Streptococcus sp   ▸  Staphylococcus aureus   ▸  Haemophilus influenzae   ▸  Klebsiella pneumoniae   ▸  Moraxella catarrhalis   ▸  Neisseria sp   ▸  Pasteurella multocida   ▸  Pseudomonas sp Fungi   ▸  Candida albicans   ▸  Aspergillus sp Streptococcus pneumoniae Preferred Regimen (sussceptible to penicillin) ▸ Penicillin G 2 million units IV q4h OR ▸ Ceftriaxone 2 g IV q24h OR Clindamycin 600 mg IV q6h Alternative Regimen (penicillin resistant strains) ▸ 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 Streptococcus pyogenes Preferred Regimen (sussceptible to penicillin) ▸ Penicillin G 2 million units IV q4h OR ▸ Ceftriaxone 2 g IV q24h OR Clindamycin 600 mg IV q6h Alternative Regimen (penicillin resistant strains) ▸ 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 Streptococcus agalactiae Preferred Regimen (sussceptible to penicillin) ▸ Penicillin G 2 million units IV q4h OR ▸ Ceftriaxone 2 g IV q24h OR Clindamycin 600 mg IV q6h Alternative Regimen (penicillin resistant strains) ▸ 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|} Streptococcus group C Preferred Regimen (sussceptible to penicillin) ▸ Penicillin G 2 million units IV q4h OR ▸ Ceftriaxone 2 g IV q24h OR Clindamycin 600 mg IV q6h Alternative Regimen (penicillin resistant strains) ▸ 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 Streptococcus angiosus Preferred Regimen (sussceptible to penicillin) ▸ Penicillin G 2 million units IV q4h OR ▸ Ceftriaxone 2 g IV q24h OR Clindamycin 600 mg IV q6h Alternative Regimen (penicillin resistant strains) ▸ 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|} Meticillin susceptible Staphylococcus aureus Preferred Regimen ▸ Nafcillin 2 g IV q4-6h OR ▸ Oxacillin 2 mg IV q4-6h OR ▸ Cefazolin 2 g IV q8h OR ▸ Vancomycin 15 mg/kg 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 ▸ TMP/SMZ 160/800 mg PO q12h Meticilling 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 (Vancomycin intermmediate sussceptibility) ▸ Linezolid 600 mg/kg IV q12h OR ▸ Daptomycin 4-6 mg/kg IV q24h OR ▸ Ceftraoline 600 mg IV q8h Alternative Regimen (Vancomycin resistance) ▸ Teicoplanin 6 mg/kg IV q12h (total of three doses), 6 mg/kg IV q24h OR ▸ Telavancin 10 mg/kg q24h (1 hour infusion) OR ▸ Linezolid 600 mg/kg IV q12h OR ▸ Daptomycin 4-6 mg/kg IV q24h 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 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 Moraxella catrrhalis Preferred Regimen ▸ Amoxicillin-clavulanic acid 850/125 mg PO q24h Alternative Regimen ▸ Azithromycin 500 mg PO q24h one day, then 250 mg PO q24h OR ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) Neisseria meningitidis Preferred Regimen ▸ Ceftriaxone 2 g IV q12h OR ▸ Cefotaxime 2 g IV q6h Alternative Regimen ▸ Penicillin G 4 million units IV q4h OR ▸ Chloramphenicol 100 mg/kg/day q6h, not exceed 4 g Neisseria gonorrhoeae Preferred Regimen ▸ Ceftriaxone 250 mg IM single dose Alternative Regimen ▸ Azithromycin 2 g PO single dose Pasteurella maltocida Preferred Regimen ▸ Penicillin VK 500 mg PO q12h OR ▸ Amoxicillin 500 mg PO q8h OR ▸ Amoxicillin-clavulanic acid 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 OR ▸ Amoxicillin-clavulanic acid 850/125 mg PO q12h Pseudomona sp Preferred Regimen ▸ Ceftazidime 2 g IV q8h OR ▸ Cefepime 2 g IV q8h PLUS ▸ Levofloxacin 750 mg IV q24h OR ▸ Moxifloxacin 400 mg PO q24h Alternative Regimen (combination of) Pseudomona sp Preferred Regimen ▸ Fluconzole 200 mg IV q24h for 14 days OR ▸ Fluconzole 200 mg PO q24h for 14 days PLUS ▸ Nystatin oral suspension PO q6h for 14 days Alternative Regimen (combination of) ▸ 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 Other treatments may include: Anti-inflammatory medicines called corticosteroids to decrease throat swelling Fluids given through a vein (by IV) References