Intravenous antibiotic therapy for acute epiglottitis

For patients with acute epiglottitis who have sepsis or septic shock, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock, immediately after blood samples are taken for culture. Collect other samples (eg swab of epiglottis, pus) as soon as possible; however, do not delay antibiotic administration to do so. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.

Pharmacokinetics may be altered in patients who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure for patients with septic shock or requiring intensive care support, modified dosages of cefotaxime, ceftriaxone, flucloxacillin and piperacillin+tazobactam are recommended. Once the critical illness has resolved, consider switching to the standard dosage.

For patients without immune compromise who have acute epiglottitis, use initially:

1ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, daily. For patients with septic shock or requiring intensive care support, use ceftriaxone 1 g (child 1 month or older: 50 mg/kg up to 1 g) intravenously, 12-hourly. Switch to oral therapy when the patient improves1 ceftriaxone ceftriaxone ceftriaxone

PLUS

flucloxacillin 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For patients with septic shock or requiring intensive care support, use flucloxacillin 2 g (child: 50 mg/kg up to 2 g) intravenously, 4-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin intravenous dosage adjustment. Switch to oral therapy when the patient improves flucloxacillin flucloxacillin flucloxacillin

OR as a single drug

1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For patients with septic shock or requiring intensive care support, use cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. Switch to oral therapy when the patient improves. cefotaxime cefotaxime cefotaxime

For patients with immune compromise who have acute epiglottitis, use initiallyAbdul-Aziz 2024Dulhunty 2024:

piperacillin+tazobactam intravenously. For dosage adjustment in adults with kidney impairment, see piperacillin+tazobactam dosage adjustment. Switch to oral therapy when the patient improves piperacillin + tazobactam piperacillin+tazobactam piperacillin+tazobactam

patients without septic shock and not requiring intensive care support: 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) 6-hourly

patients with septic shock or requiring intensive care support: 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) administered as a loading dose over 30 minutes. After 3 hours, start a continuous infusion of 16+2 g (child: 400+50 mg/kg up to 16+2 g) administered over 24 hours2.

Patients at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection require treatment with vancomycin. In the ceftriaxone-based regimen, replace flucloxacillin with vancomycin; in the cefotaxime- or piperacillin+tazobactam-based regimens, add vancomycin. Use initially:

vancomycin intravenously; switch to oral therapy when the patient improves vancomycin vancomycin vancomycin

adult: 25 mg/kg (actual body weight) rounded up to nearest 125 mg, up to 3 g, as a loading dose. See Calculated vancomycin loading dosage in critically ill adults for calculated weight-based loading doses. Subsequent doses are dependent on weight and kidney function; see Intermittent vancomycin dosing for critically ill adults

child: for initial vancomycin dosing, see Intermittent vancomycin dosing for young infants and children.

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefotaxime alone or ceftriaxone plus vancomycin (see dosages above).

For patients who have had severe immediate3 hypersensitivity reaction to a penicillin, cefotaxime alone or ceftriaxone plus vancomycin (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For patients who have had a severe immediate3 hypersensitivity reaction to a penicillin in whom cefotaxime or ceftriaxone plus vancomycin is not used, or for patients who have had a severe delayed4 hypersensitivity reaction to a penicillin, use initially:

moxifloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. Switch to oral therapy when the patient improves5. moxifloxacin moxifloxacin moxifloxacin

1 Because methicillin-susceptible Staphylococcus aureus (MSSA) is highly likely, flucloxacillin is added to ceftriaxone to ensure adequate activity against MSSA; for more information, see Practical information on using beta lactams: cephalosporins.Return
2 For patients with septic shock or requiring intensive care support, administering the total daily dose of piperacillin+tazobactam over 24 hours is preferred to ensure adequate drug exposure. If this is not possible (eg the patient is receiving other drugs via the same line), administer the standard dose (4+0.5 g [child: 100+12.5 mg/kg up to 4+0.5 g] intravenously, 6-hourly) as an extended infusion over 3 hours. If a 3-hour infusion is not possible, administer over 30 minutes. For more information, see Practical information on using beta lactams: penicillins.Return
3 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
4 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return
5 Moxifloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Moxifloxacin can be used in children when it is the drug of choice.Return