Epiglottitis and Supraglottitis

Case Definition:

Previously common as an acute infection of the epiglottis in children caused by Haemophilus influenzae Type B.  This is now rare due to widespread immunisation. Adult cases are now more common in the UK. The term supraglottitis is used as the entire supraglottic area is usually involved. Several organisms are implicated.

  

Diagnostic criteria:

Rapidly developing progressive upper airway obstruction characterised by stridor. In adults a sore throat is usually present together with dysphagia. In children and adults the symptoms can progress rapidly and airway management e.g. endotracheal intubation or tracheostomy may be necessary.

 

Specimens to be collected:

  • Throat swab for bacterial culture if possible but only when the airway is stable.

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A/B/C

Minor to severe life threatening infection 

Review doses in renal impairment

CEFTRIAXONE 2g iv od

Typical total duration: 7-10 days

Severe Penicillin Allergy: 

LEVOFLOXACIN 500mg po/iv bd
(Oral route preferred. Consider reducing to 500mg od if patient clearly improving)

plus

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Typical total duration: 7-10 days

 

 IV to Oral Switch (explanatory notes)

 CO-AMOXICLAV 625 po tds

Typical total duration: 7-10 days

 

LEVOFLOXACIN 500mg po od

Typical total duration: 7-10 days

Last reviewed 23/04/14

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)