Acute Epiglottitis

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This is an acute and life-threatening infection in which the epiglottis and surrounding tissue become acutely inflamed and oedematous causing severe obstruction of the upper airways. The disease tends to run an extremely rapid course (4-6 hours) to respiratory failure and death.

It is more common in children. However, the incidence has reduced significantly due to the current immunisation schedule with the pentavalent vaccine.

Examination of the throat in patients with this condition must be done only in the presence of a doctor capable and ready to intubate. 

Cause

  • Haemophilus influenzae type B
  • Streptococcus pyogenes 
  • Streptococcus pneumoniae
  • Staphylococcus aureus

Symptoms

  • Sudden onset of high fever
  • Drooling of saliva 
  • Dysphagia
  • Breathing difficulty

Signs

  • Extremely ill and toxic child
  • Fever
  • Head is held forward to extend the neck
  • Breathing difficulty  
  • Weak voice (not hoarse) 
  • Reduced air entry on auscultation
  • Stridor
  • Cyanosis in very sick children
  • Swollen and reddened epiglottis

Investigations

  • FBC
  • Blood culture
  • Lateral soft tissue X-ray of the neck

TreatmentTreatment Objectives

  • To relieve obstruction 
  • To treat bacteraemia

Non-pharmacological treatment

  • Establishment of airway if necessary by intubation or tracheostomy 

Pharmacological treatment

For treatment of bacterial infection

1st Line Treatment

Evidence Rating: [B]

  • Cefuroxime, IV,

Adults

750 mg-1.5 g 8 hourly for 7 days

Children

25 mg/kg 8 hourly for 7 days

And

  • Metronidazole, IV,

Adults

500 mg 8 hourly for 7 days

Children

7.5 mg/kg 6 hourly for 7 days

2nd Line Treatment 

Evidence Rating: [B]

  • Cefotaxime, IV, 

Adults 

1-2 g IV or IM 8 hourly for 7 days

Children

50 mg/kg 8 hourly for 7 days

Or 

  • Amoxicillin + Clavulanic Acid, IV,

Adults

1.2 g 12 hourly, 

Increased to 1.2 g 8 hourly for 7 days in severe infections 

Children

12-18 years; 600 mg to 1.2 g 12 hourly, increased to 1.2g 8 hourly for 7 days in severe infections

3 months-12 years; 30 mg/kg 12 hourly, increased to 30 mg/kg 8 hourly for 7 days in severe infections

7 days-3 months; 30 mg/kg 8 hourly for 7 days

Preterm and < 7 days; 30 mg/kg 12 hourly for 7 days

Note: Treatment should be changed to oral antibiotics when appropriate and continued for a total of 7 days 

Referral CriteriaRefer all patients immediately to a specialist if there is no expertise available for intubation or tracheostomy.