Epiglottitis Treatment

Key Takeaways

• Epiglottitis is a medical emergency; call for urgent evaluation and avoid actions that might upset the patient.

• Keep the airway secure and monitored continuously, give supplemental oxygen, and be ready for urgent intubation or tracheostomy if required.

• Begin empiric IV antibiotics promptly—typically a third‑generation cephalosporin plus antistaphylococcal coverage.

• Use IV dexamethasone and supportive care (humidified oxygen, pain control, IV fluids) to help reduce swelling and relieve symptoms.

• Admit patients to a high‑acuity unit for continuous observation, daily reassessment (for example, nasolaryngoscopy), and antibiotic adjustments based on cultures.

Understanding Epiglottitis and When to Seek Emergency Care

When is epiglottitis an emergency? Epiglottitis is a serious bacterial infection that can cause fast swelling of the epiglottis and nearby supraglottic tissues, risking airway obstruction. Suspect it when someone has a severe sore throat, trouble breathing, noisy breathing (stridor), drooling, or sudden worsening. These signs need immediate emergency care: call emergency services, keep the person upright, and avoid anything that might distress them. Hospital evaluation focuses on close airway monitoring and being ready to escalate support if obstruction progresses. Treatment combines prompt IV antibiotics with supportive measures like IV fluids and steroids to reduce swelling. HiB vaccination has cut pediatric cases, but adults still get epiglottitis; decisions about hospitalization and contact prophylaxis depend on how sick the patient is and the microbiology results.

Immediate Airway Management and Stabilization

Protecting the airway is the top priority in suspected epiglottitis. Clinicians continuously assess breathing and oxygen saturation to decide on oxygen, advanced airway steps, or urgent transfer to an operating room or ICU. Keep the patient calm and positioned to help breathing while preparing definitive airway control. ENT or airway specialists may perform an awake fiberoptic evaluation to view supraglottic swelling before intubation. If the risk of obstruction is high, controlled urgent intubation or an awake tracheostomy is performed. While teams prepare, adjuncts such as nebulized epinephrine and IV steroids can help reduce edema. After the airway is secured, the patient is moved to a high‑acuity unit for ongoing monitoring until swelling improves and extubation is appropriate.

Antimicrobial and Anti-inflammatory Treatments

How are antibiotics and anti‑inflammatory treatments used together? Start empiric intravenous antibiotics right away—typically a third‑generation cephalosporin plus an antistaphylococcal agent—then narrow therapy when cultures identify pathogens like Haemophilus influenzae type b, Streptococcus species, or Staphylococcus aureus (including MRSA concerns). IV therapy delivers drug levels quickly to limit infection and airway edema. Anti‑inflammatory treatment usually includes glucocorticoids (for example, IV dexamethasone 4–10 mg bolus with follow‑up dosing) to try to reduce swelling, recognizing the evidence varies. Nebulized epinephrine can provide temporary relief of upper airway edema. Antibiotic choice, steroid use, and other adjuncts should align with the airway plan and be adjusted once microbiology results return.

Supportive Care, Monitoring, and Hospitalization

Where should care happen after epiglottitis is suspected? Care belongs in settings with immediate access to airway management and ICU monitoring. Patients are admitted to high‑acuity units for continuous observation, pulse oximetry, and readiness for endotracheal intubation or awake tracheostomy if swelling worsens. IV antibiotics are started to cover likely pathogens and then tailored by culture results. Adjunctive IV dexamethasone is commonly used to reduce supraglottic edema while humidified oxygen, analgesics, and IV fluids support the patient. Daily nasolaryngoscopy or repeat airway checks track edema resolution and help decide when to extubate or decannulate. Patients remain hospitalized until the airway is secure, inflammatory signs improve, and clinicians confirm stable recovery before discharge or transfer.

Prevention, Vaccination, and Follow-up Care

Why focus on prevention with vaccination and risk reduction? HiB vaccination has dramatically lowered pediatric epiglottitis; the primary series (given at 2–4 or 2–4–6 months) with a booster at 12–15 months provides early protection. Prevention also includes addressing modifiable risks such as tobacco exposure, which raises risk in adults. Even with vaccination, non‑HiB organisms can cause epiglottitis, so clinicians watch for symptoms in adults and unimmunized kids. Vaccination status helps guide contact management and, in select cases, antibiotic prophylaxis. Follow‑up care after the acute phase includes rechecking airway symptoms, confirming full clinical recovery, and reviewing immunization records to complete missed HiB doses. Clear follow‑up instructions for families and timely primary care visits reduce the chance of delayed problems.