Medication Summary
Antibiotic therapy should begin after blood and epiglottic cultures have been obtained. Antipyretic agents may also be necessary. Racemic epinephrine, corticosteroids, and beta-agonists have not been proven to be helpful in epiglottitis. In addition, corticosteroid usage remains controversial, as anecdotal reports in the past had supported its use.
A study by Lee et al indicated that the treatment of epiglottic abscess with a combination of needle aspiration and antibiotics can reduce hospitalization time for patients below that for patients treated with antibiotics alone. However, the study also found that outcomes of the two treatments did not significantly differ, with significant symptom improvement achieved in both groups. [33]
A study from Beijing that looked at more than 8.5 million outpatient cases of acute upper respiratory tract infection in tertiary hospitals found that the highest antibiotic prescription rate (73.6%) was for acute tonsillitis, sinusitis, and epiglottitis. The overall antibiotic prescription rate was 39.0%. [34]
Antibiotics
Class Summary
Empiric coverage for Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae should be provided (a third-generation cephalosporin or amoxicillin/clavulanic acid) in the management of epiglottitis. Third-generation cephalosporins are preferred as first-line agents because of increasing resistance to ampicillin.
Ceftriaxone (Rocephin)
Ceftriaxone is the antibiotic of choice (DOC) for epiglottitis. This agent is a third-generation cephalosporin with broad-spectrum activity against gram-negative organisms, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. By binding to one or more penicillin-binding proteins, ceftriaxone arrests bacterial cell wall synthesis and bacterial growth.
Ampicillin and sulbactam (Unasyn)
Ampicillin with sulbactam is the drug combination of a beta-lactamase inhibitor with ampicillin. This combination interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms.
Ampicillin with sulbactam is used as an alternative to amoxicillin when the patient is unable to take medication orally. This combination covers skin, enteric flora, and anaerobes but is not ideal for nosocomial pathogens.
Chloramphenicol
Chloramphenicol is used if patients are allergic to penicillin and cephalosporins. This agent binds to the 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Chloramphenicol is effective against gram-negative and gram-positive bacteria.
Cefuroxime (Zinacef, Ceftin)
Cefuroxime is a second-generation cephalosporin antibiotic with activity against gram-positive and some gram-negative bacteria, including Haemophilus influenzae. Cefuroxime binds to penicillin-binding proteins and inhibits the final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death.
Cefotaxime (Claforan)
Cefotaxime is another third-generation cephalosporin antibiotic with broad-spectrum activity against gram-positive and gram-negative bacteria. This agent binds to penicillin-binding proteins and inhibits the final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death.
Clindamycin (Cleocin)
Clindamycin is a semisynthetic antibiotic produced by the 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin. This agent inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Clindamycin widely distributes in the body, without penetration of the central nervous system. This agent is protein bound and excreted by the liver and kidneys.
Analgesic-antipyretics
Class Summary
Analgesic-antipyretic agents are helpful in relieving the lethargy, malaise, and fever associated with epiglottitis.
Aspirin (Anacin, Aspercin, Bayer Aspirin)
Aspirin blocks prostaglandin synthetase action, which, in turn, inhibits prostaglandin synthesis and prevents the formation of platelet-aggregating thromboxane A2. This agent acts on the hypothalamus heat-regulating center to reduce fever. The dissipation of heat is enhanced by vasodilation of the peripheral vessels, causing a decrease in body temperature.
Acetaminophen (Tylenol, Acephen, Aspirin-Free Anacin)
Acetaminophen is the drug of choice (DOC) for treating pain in patients with documented hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), those with upper gastrointestinal disease, or those who take oral anticoagulants. This agent reduces fever by a direct action on the hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.
Ibuprofen (NeoProfen, Advil, Motrin)
Ibuprofen is usually the drug of choice (DOC) for treating mild to moderate pain, if no contraindications exist. This agent inhibits inflammatory reactions and pain, probably by decreasing the activity of the cyclooxygenase enzyme, which inhibits prostaglandin synthesis. Ibuprofen is one of the few nonsteroidal anti-inflammatory drugs (NSAIDs) that is indicated for reduction of fever.
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Soft-tissue lateral neck radiograph reveals edema of epiglottis consistent with acute epiglottitis.
