Epiglottitis Treatment: Medical Treatment
Currently, immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected. The person is in danger of sudden and unpredictable closing of the airway. So doctors must establish a secure way for the person to breathe. Antibiotics may be given.
- Initial treatment of epiglottitis may consist of making the person as comfortable as possible. For instance, an ill child may be placed in a dimly lit room with the parent holding the child. Then humidified oxygen may be added while the child is closely monitored. 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 or intensive care unit with proper staff and airway intervention equipment. In very 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 control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually obtained with the premise that any organism found growing in the blood can be attributed as the cause of the epiglottitis. However, in many cases, blood cultures may fail to yield this information.
- Corticosteroids and epinephrine have been used in the past. However, there is no good proof that these medications are helpful in cases of epiglottitis.
Next Steps: Follow-up
Follow-up involves continuing to take all antibiotics until the full course is completed, keeping all follow-up appointments with the doctor and with the surgeon if a breathing tube had to be placed through the neck. The surgeon will remove the tube and make sure the site is healing well. 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.
Epiglottitis can often be prevented with proper vaccination against H influenza type b (Hib). Therefore it is important that your doctor make the appropriate recommendations for vaccination against Hib for children (see the children's immunization schedule). Adult vaccination is not routinely recommended, except for people with immune problems such as sickle cell anemia, splenectomy (removal of the spleen), cancers, or other diseases affecting the immune system.
Preventive medication (rifampin, Rifadin) should be given to all household contacts of a child who has been exposed to H influenza and who:
- Is under age 4 years and has not received all the Hib vaccinations
- Is under 12 months and has not finished the first series of Hib vaccine
- Has a weakened immune system.
This is 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.