How is epiglottitis treated in patients with Haemophilus influenzae infections?

Updated: Jul 02, 2019
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Maintenance of a patent airway via intubation or tracheostomy is the mainstay of treatment for epiglottitis.

If a patient presents with evidence of respiratory compromise, the following steps should be taken: [81]

  • Administer oxygen support via face mask (eg, 60%).
  • Consult with an otorhinolaryngologist or anesthesiologist so that the patient's airway can be secured either via intubation or creation of a surgical airway.
  • If feasible, bring the patient to the operating room to secure and assess the airway and to swab the epiglottis. Heliox and 4 mL of nebulized 1:1,000 epinephrine may be administered for airway improvement to facilitate transfer.
  • Administer intravenous dexamethasone (eg, approximately 4 mg every 6 hours).

Intravenous ceftriaxone 2 g once daily (after blood culture specimens have been drawn) is recommended until the patient is clinically well and able to swallow; afterward, it can be switched to an oral equivalent (eg, amoxicillin/clavulanate 625 mg thrice daily), although culture and susceptibility results must be taken into consideration. The total antimicrobial treatment course should be 7 days (up to 10 days). In patients with penicillin anaphylaxis and/or severe allergies to cephalosporins, intravenous vancomycin plus ciprofloxacin parenterally 400 mg every 12 hours is the recommended regimen. Once the patient is clinically well, the said regimen should be switched to a fluoroquinolone to complete a total course of 7 days (up to 10 days). [81, 82]


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