Epiglottitis


Bacterial infection of the epiglottis in young children caused by Haemophilus influenzae (Hib), it is rare when Hib vaccine coverage is high. It can be caused by other bacteria and occur in adults.

Clinical features

– Rapid (less than 12-24 hours) onset of high fever.
– Typical “tripod or sniffing” position, preferring to sit, leaning forward with an open mouth, anxious appearing.
– Difficulty swallowing, drooling, and respiratory distress.
– Stridor may be present (as opposed to croup, hoarse voice and cough are usually absent).
– Critically ill appearing1 .

Allow the child to sit in a comfortable position or on the parent’s lap. Do not force them to lie down (may precipitate airway obstruction). Avoid any examination that will upset the child including examination of the mouth and throat.

Treatment

– In case of imminent airway obstruction, emergency intubation or tracheotomy is indicated. The intubation is technically difficult and should be performed under anaesthesia by a physician familiar with the procedure. Be prepared to perform a tracheotomy if intubation is unsuccessful.
– In all cases:
• Insert a peripheral IV line and provide IV hydration.
• Antibiotherapy:
ceftriaxone slow IV (3 minutes) or IV infusion (30 minutes)2 . Avoid IM route (may agitate the child and precipitate a respiratory arrest).
Children: 50 mg/kg once daily
Adults: 1 g once daily
The IV treatment is administered for at least 5 days then, if the clinical condition has improved3 and oral treatment can be tolerated, change to:
amoxicillin/clavulanic acid (co-amoxiclav) PO to complete a total of 7 to 10 days of treatment. Use formulations in a ratio of 8:1 or 7:1 exclusively. The dose is expressed in amoxicillin:
Children < 40 kg: 50 mg/kg 2 times daily
Children ≥ 40 kg and adult:
Ratio 8:1: 3000 mg daily (2 tablets of 500/62.5 mg 3 times daily)
Ratio 7:1: 2625 mg daily (1 tablet of 875/125 mg 3 times daily)



Footnotes
Ref Notes
1 Critically ill appearing child: weak grunting or crying, drowsiness, difficult to arrouse, does not smile, unconjugate or anxious gaze, pallor or cyanosis, general hypotonia.
2 For administration by IV route, ceftriaxone powder should to be reconstituted in water for injection only. For administration by IV infusion, dilute each dose of ceftriaxone in 5 ml/kg of 0.9% sodium chloride or 5% glucose in children less than 20 kg and in a bag of 100 ml of 0.9% sodium chloride or 5% glucose in children over 20 kg and in adults.
3 Improvement criteria include: fever reduction, diminished respiratory distress, improved SpO2, improved appetite and/or activity.