Acute Epiglottitis (AE)

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Epiglottitis is an acute infectious inflammation of the epiglottis, supraglottic and hypopharynx which occurs both in children and adults. It is commonly caused by Haemophilus influenzae. Epiglottitis is a potentially lethal condition especially in children.

Oedema of the epiglottis may cause acute airway obstruction.

Signs and symptoms

  • Throat pain and difficulty in swallowing
  • Drooling
  • Husky voice
  • Fever often high and with chills
  • Patient prefers sitting posture with an extended neck
  • Laborious inspiration
  • Cough in some cases
  • Anxiety

Investigations:

Plain X-ray of the neck, lateral view characteristically presents with a positive thumb sign (oedematous epiglottis).

Non-pharmacological treatment:

  • Immediate hospitalization, preferably in the ICU
  • Transportation: sitting, with oxygen supplementation
  • Be prepared to treat respiratory failure (intubation or tracheotomy)

Pharmacological treatment

Phenoxymethylpenicillin oral

Adult:

500mg every 8 hours for 7 days.

Child:

Up to 5 years: 6 mg/kg every 6 hours for 10 days

OR

Azithromycin oral

Adult:

500mg once daily for 3 days.

Child:

10mg/kg once daily for 3 days

OR

Amoxicillin/clavulanic acid oral

Adult:

625mg (500mg amoxicillin+125mg Clavulanic acid) every 8 hours for 7 days

Child:

375mg (250mg amoxicillin+125 Clavulanic acid) every 12 hours for 7 days;

AND

Paracetamol oral until fever is controlled

Adult:

1gm every 8 hours

Child:

10 mg/kg body weight every 8 hours