From the Research
Management of epiglottitis requires immediate airway protection and antimicrobial therapy, with the most recent and highest quality study 1 emphasizing the importance of developing standardized treatment protocols for acute epiglottitis in adults.
Key Considerations
- Patients should be hospitalized with continuous monitoring and evaluation by an otolaryngologist and anesthesiologist for potential airway intervention.
- Secure the airway through endotracheal intubation in a controlled setting like an operating room, with equipment for emergency cricothyroidotomy available, as highlighted in 1.
- Avoid agitating the patient or examining the throat with a tongue depressor, which could precipitate complete airway obstruction.
Antimicrobial Therapy
- Administer empiric intravenous antibiotics immediately, typically ceftriaxone (1-2g IV every 24 hours for adults; 50-75 mg/kg/day for children) plus vancomycin (15-20 mg/kg IV every 8-12 hours for adults; 10-15 mg/kg IV every 6 hours for children) to cover Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus, as recommended in 2.
- Adjust antibiotics based on culture results, typically continuing for 7-10 days.
Additional Measures
- Corticosteroids like dexamethasone (0.6 mg/kg/day in divided doses) may help reduce airway edema, as suggested in 3.
- Maintain the patient in a position of comfort, often sitting upright, with supplemental oxygen as needed.
- Racemic epinephrine nebulization may temporarily reduce airway swelling in less severe cases.
Prognosis and Outcome
- Epiglottitis is life-threatening due to potential complete airway obstruction from the inflamed epiglottis and surrounding tissues, requiring prompt recognition and management, as emphasized in 4.
- With proper treatment, including selective airway intervention, antimicrobial therapy, and close monitoring, the prognosis is good, as reported in 1 and 4.