From the Research
For glottitis and epiglottitis, the recommended antibiotics are third-generation cephalosporins such as ceftriaxone (1-2g IV every 24 hours) or cefotaxime (1-2g IV every 8 hours), often combined with vancomycin (15-20 mg/kg IV every 8-12 hours) for broader coverage, as seen in a study from 1 where ceftriaxone was the commonest empirical antibiotic prescribed.
Key Considerations
- The most common causative organisms are Haemophilus influenzae type b, Streptococcus pneumoniae, and Staphylococcus aureus, which is why broad-spectrum coverage is necessary 2.
- In children, ampicillin-sulbactam (50 mg/kg IV every 6 hours) may be used as an alternative, as shown in a study from 2 where the combination of sulbactam and ampicillin appeared to be an effective and safe alternative to chloramphenicol/ampicillin therapy for acute epiglottitis in infants and children.
- Airway management is equally critical, and patients often require hospitalization with close monitoring for respiratory distress, with 7 patients requiring airway intervention in the study from 1.
- Corticosteroids like dexamethasone (10 mg IV initially, then 4 mg every 6 hours) are typically administered alongside antibiotics to reduce inflammation and edema.
- Antibiotic therapy should be adjusted based on culture results when available, and treatment should continue for 7-10 days, with transition to oral antibiotics once clinical improvement occurs.
Additional Points
- A study from 3 highlighted the importance of routine drawing of blood culture in supraglottitis patients to lead to higher detection rates of Neisseria meningitidis cases.
- Another study from 4 demonstrated the effectiveness of IV antibiotics plus corticosteroids in treating epiglottitis, with the patient showing improvement after treatment.
- The study from 5 showed that ceftriaxone as a single daily intravenous dose for 5 days was effective in treating Haemophilus influenzae epiglottitis, with all children responding favourably to the treatment.