What is the treatment for viral and bacterial laryngitis?

Treatment of Viral and Bacterial Laryngitis

For viral laryngitis, antibiotics should NOT be prescribed—focus on symptomatic relief with analgesics, hydration, and voice rest; for bacterial laryngitis (epiglottitis), immediate treatment with antibiotics (ampicillin or amoxicillin-clavulanate) plus systemic corticosteroids is essential, often requiring airway protection. 1, 2, 3

Viral Laryngitis Management

Primary Treatment Approach

• Symptomatic relief is the cornerstone of management, including analgesics or antipyretics for pain/fever, adequate hydration, and voice rest to reduce vocal fold irritation 1
• Common viral causes include parainfluenza viruses, rhinovirus, influenza, and adenovirus 1

What NOT to Do

• Antibiotics have no objective benefit in treating acute viral laryngitis and should not be routinely prescribed 1, 4
• A Cochrane review of 351 participants found antibiotics ineffective for objective voice outcomes in acute laryngitis 4
• Antibiotic misuse contributes to bacterial resistance, unnecessary costs, potential side effects, and risk of laryngeal candidiasis 1
• Systemic corticosteroids should not be routinely used in adults with viral laryngitis due to lack of efficacy evidence and potential for significant adverse effects 1

When to Reconsider or Escalate

• Consider additional evaluation if symptoms persist beyond 2-3 weeks, progressive worsening occurs, signs of airway compromise develop, or bacterial superinfection is suspected 1
• Antibiotics may be appropriate for immunocompromised patients, confirmed bacterial infection, or bacterial laryngotracheitis with mucosal crusting and increased work of breathing 1

Bacterial Laryngitis (Epiglottitis) Management

Recognition and Diagnosis

• Acute supraglottic laryngitis (epiglottitis) is a bacterial infection, most commonly caused by Haemophilus influenzae type B 2, 3
• Characteristic finding is a swollen, red epiglottis 3
• This is a medical emergency requiring immediate intervention 2, 3

Treatment Protocol

• Immediate antibiotic therapy with ampicillin or amoxicillin-clavulanate 3
• Systemic corticosteroids (hydrocortisone-sodium succinate) administered intramuscularly 3
• Air humidification and intravenous fluids 3
• Airway protection is critical—tracheotomy or intubation may be necessary 2, 3

Subglottic Bacterial Laryngitis

• Subglottic laryngitis related to bacterial infections requires antibiotics in combination with corticosteroids 2
• Emergency administration of systemic and inhaled glucocorticoids in hospital setting is basic treatment for glotto-subglottic laryngitis 2
• Dosage must be high: more than 0.3 mg/kg dexamethasone for 48 hours, followed by oral corticosteroids 2

Critical Distinction: Viral vs. Bacterial

Clinical Differentiation

• Dyspnea is the leading sign of acute laryngitis and is more frequent in children, related to disease severity 2
• Dysphonia is the leading sign of chronic laryngitis 2
• Epiglottitis (supraglottic) is bacterial; subglottic laryngitis is typically viral 2
• Epiglottitis can occur in adults where it is as severe as in children 2

Common Pitfall

The most significant error is prescribing antibiotics for viral laryngitis. The evidence is clear that antibiotics provide no objective benefit for viral cases and contribute to antimicrobial resistance 1, 4. However, missing bacterial epiglottitis can be life-threatening, so maintain high clinical suspicion for airway compromise and bacterial features 2, 3.