Treatment of Epiglottitis
Epiglottitis requires immediate airway management and antibiotic therapy, with the highest priority being to secure the airway in a controlled setting with appropriate expertise available.
Immediate Management
Airway Management
- Do not attempt to examine the throat or obtain throat cultures in suspected epiglottitis as this may precipitate complete airway obstruction 1
- Secure the airway in a controlled environment with equipment and personnel prepared for emergency intervention
- Options for airway management include:
Antimicrobial Therapy
- Initiate empiric broad-spectrum antibiotics immediately after securing the airway and obtaining blood cultures
- Common regimen: Cefotaxime plus metronidazole 2
- Target coverage for Haemophilus influenzae type b, which is found in up to 97% of pediatric cases 3
Clinical Assessment
Key Clinical Features
- Sore throat (present in 94% of cases) 2
- Fever
- Respiratory distress
- Dysphagia
- Drooling
- Muffled voice ("hot potato" voice)
- Sitting forward position (tripod position)
Diagnostic Approach
- Lateral neck radiograph - quick, safe and reliable diagnostic tool showing thickened epiglottis 3
- Direct visualization of inflamed epiglottis via laryngoscopy (only in controlled setting) 2
- Blood cultures before antibiotic administration
Special Considerations
Adult vs. Pediatric Management
- Adult epiglottitis often has a more indolent course than pediatric cases
- Pediatric cases almost always require immediate airway intervention
- Adult cases may sometimes be managed with close observation if mild 2
High-Risk Patients
- Patients with diabetes mellitus (most common comorbidity, 11% of cases) 2
- History of nasopharyngeal carcinoma
- Previous episodes of epiglottitis
- Immunocompromised status
Complications and Follow-up
Potential Complications
- Complete airway obstruction
- Epiglottic abscess requiring surgical drainage 4
- Need for prolonged intubation or tracheostomy
Recovery and Follow-up
- Most patients recover fully with proper treatment 4
- Monitor for signs of improvement including decreased epiglottic swelling
- Consider extubation when inflammation has resolved
- Follow extubation protocols to minimize complications 1
Pitfalls to Avoid
- Never attempt throat examination or cultures without airway protection
- Never delay antibiotics once airway is secured
- Never discharge patients with suspected epiglottitis without thorough evaluation
- Never extubate prematurely before resolution of epiglottic swelling
With proper management including selective airway intervention, appropriate antimicrobial therapy, and close monitoring, the prognosis for epiglottitis is generally good 4, 2.