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]

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 antibiotics. Appropriate antibiotic regimens with coverage of Streptococcus pneumoniae, beta-hemolytic streptococci, and Staphylococcus aureus include parenteral cefotaxime or ceftriaxone in combination with vancomycin (or levofloxacin in combination with clindamycin for penicillin-allergic patients). The use of racemic epinephrine or systemic corticosteroids does not shorten hospital stay nor reduce the need of artificial airway and is not recommended in routine practice. Postexposure prophylaxis with rifampin should be given to selected household contacts when a Haemophilus influenzae epiglottitis is diagnosed.

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 References