Medication Summary
Antibiotic therapy is necessary in the management of epiglottitis but should be initiated after the airway is secured. Before obtaining culture results, use antibiotics for the most likely organisms. Following trauma to the epiglottis, Staphylococcus aureus should be suspected. With the presence of white patches, Candida albicans should be suspected. Sedation for comfort is also required.
Antibiotic agents
Class Summary
Initiate antibiotics to provide empiric coverage of the most likely bacterial pathogens in the context of the clinical setting. Treatment should continue for 7-10 days, in general.
Ceftriaxone (Rocephin)
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against gram-negative bacteria, including Haemophilus influenzae, Enterobacteriaceae, and Neisseria species, and variable activity against gram-positive bacteria. This agent binds to penicillin-binding proteins and inhibits the final transpeptidation step of peptidoglycan synthesis, resulting in cell wall destruction and death of the organism.
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 destruction and death of the organism.
Cefuroxime (Zinacef , Kefurox)
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 destruction and death of the organism.
Chloramphenicol
When combined with ampicillin, chloramphenicol is an alternative agent if cephalosporins are unable to be used. This agent elicits activity against some gram-positive, gram-negative, and anaerobic organisms by inhibiting protein synthesis via reversibly binding to the 50S ribosomal subunit. Although unavailable in the United States, this antibiotic remains in use in parts of the world.
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. It is useful for gram-positive infections, including most community-associated MRSA disease. 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 drug is protein bound and excreted by the liver and kidneys.
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.
Rifampin (Rifadin)
Rifampin is used for chemoprophylaxis in Hib infections.
Analgesic-Antipyretics
Class Summary
Analgesic-antipyretic agents are helpful in relieving the lethargy, malaise, and fever associated with epiglottitis.
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 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) indicated for fever reduction.
Vaccines, Inactivated (Bacterial)
Class Summary
These agents are used to induce active immunization against Haemophilus influenza type b.
Haemophilus b conjugate vaccine (ActHIB, Hiberix, PedvaxHIB)
This vaccine is used for routine immunization of children against invasive diseases caused by H influenzae type b by decreasing nasopharyngeal colonization. The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that all children receive one of the conjugate vaccines licensed for infant use beginning routinely at age 2 months.
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Swollen epiglottis with characteristic thumbprint sign.
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Comparison of a normal pediatric airway (bottom) and airway from a child who died from epiglottitis (top).
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Child assuming the sniffing position with upper airway obstruction.
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Swollen epiglottis with characteristic thumbprint sign.
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Radiograph of a child with acute epiglottitis; note the hypopharyngeal dilatation, obliteration of the vallecula, and thickened aryepiglottic folds—a positive thumb sign.
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Correct positioning for a cricothyroid needle insertion
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Child with acute epiglottitis after intubation. Note cherry red epiglottis. This image was taken in 2008 and the child was completely immunized and grew HiB from surface culture.
