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Epiglottitis (cont.)

What is the treatment for epiglottitis?

Patient Comments

Currently, immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected since the person is in danger of sudden and unpredictable closing of the airway. Doctors must establish a secure way for the person to breathe. Antibiotics may be prescribed to the patient.

  • Initial treatment of epiglottitis may consist of making the patient as comfortable as possible including placing an ill child in a dimly lit room with the parent holding the child, humidified oxygen, and close monitoring. If there are no signs of respiratory distress, IV fluids may be helpful. It is important to prevent anxiety because it may lead to an acute airway obstruction, especially in children.
  • People with possible signs of airway obstruction require laryngoscopy in the operating room with proper staff and airway intervention equipment. In severe cases, the doctor may need to perform a cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe).
  • IV antibiotics may effectively clear infection and control inflammation in the body. Antibiotics usually are prescribed to treat the most common types of bacteria. Blood cultures usually are obtained with the premise that any organism found growing in the blood can be attributed as the cause of the epiglottitis.
  • Corticosteroids and epinephrine are used, but there is no good evidence these medications are helpful in cases of epiglottitis.

Patients should continue taking all antibiotics until the full course is completed. They should keep all follow-up appointments with the doctor. Most people improve significantly before leaving the hospital, so taking the antibiotics and returning to the hospital if there are any problems are the most important parts of follow-up.

How can epiglottitis be prevented?

Prevention of epiglottitis can be achieved with proper vaccination against H. influenza type b (Hib). It is important that children are vaccinated against Hib. Adult vaccination is not routinely recommended, except for people with immune-related medical conditions such as sickle cell anemia, splenectomy, cancers, or other diseases affecting the immune system.

When there is a member of a family with an unvaccinated child under age 4 years of age who is exposed to a person with H influenza epiglottitis, preventive medication such as rifampin (Rifadin) should be given to all household contacts to make sure that both the person with the illness and the rest of the household have the bacteria completely eradicated from their bodies. This prevents formation of a "carrier state" in which a person has the bacteria in the body but is not actively sick. Carriers can still spread the infection to other family members even though they are not ill.

What is the outlook for a person with epiglottitis?

A person with epiglottitis can recover very well if the condition is caught early and treated in time. A majority of people with epiglottitis do well and recover without problems. But if the person was not taken to the hospital early, and was not appropriately diagnosed and treated, the prognosis is poor with the possibilities of prolonged physical handicap and even death.

  • Before the Hib vaccine, mortality rates from epiglottitis were much higher. With current vaccination programs along with earlier recognition and treatment, the overall death rate from epiglottitis is estimated to be less than 0.89% - approximately 36 cases per year. The death rate from epiglottitis in adults is higher than that of children because the condition may be misdiagnosed.
  • Epiglottitis also can occur with other infections in adults, such as pneumonia. Most commonly, it is misdiagnosed as a strep throat. However, if it is suspected and treated appropriately, full recovery can be anticipated. Most of the deaths come from failure to diagnose epiglottitis in a timely fashion and resulting obstruction of the airway. As with any serious infection, bacteria may enter the blood, a condition called bacteremia, which may result in infections in other systems and sepsis (severe infection with shock, and often respiratory failure).

REFERENCES:

"Haemophilus influenzae Disease (Including Hib)." CDC.gov. Updated Jun 14, 2016.
<http://www.cdc.gov/hi-disease/clinicians.html>

DiMuzio, B. et al. "Thumb sign of epiglottitis." Radiopaedia.org:
<http://radiopaedia.org/articles/thumb-sign-of-epiglottitis>

John Udeani, M. F., MD. "Pediatric Epiglottitis Clinical Presentation." Medscape. Updated Jan 14, 2016.
<http://emedicine.medscape.com/article/963773-clinical>


Medically Reviewed by a Doctor on 7/28/2016
Medical Editor:

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Read What Your Physician is Reading on Medscape

Epiglottitis »

Epiglottitis, also termed supraglottitis or epiglottiditis, is an inflammation of structures above the insertion of the glottis.

Read More on Medscape Reference »


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