Related Experiment Videos
Successful treatment of epiglottitis with two doses of ceftriaxone
S M Sawyer1, P D Johnson, G G Hogg
1Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
A short course of ceftriaxone effectively treats childhood epiglottitis, caused by Haemophilus influenzae type b. This safe and economical alternative to standard chloramphenicol treatment shows comparable outcomes and eradication rates.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Clinical Pharmacology
Background:
- Childhood epiglottitis is primarily caused by Haemophilus influenzae type b (Hib).
- Standard treatment involves a five-day course of chloramphenicol.
- Third-generation cephalosporins are increasingly used for invasive Hib infections, with preliminary success in epiglottitis.
Purpose of the Study:
- To compare the efficacy of a two-day ceftriaxone course versus a five-day chloramphenicol course for childhood epiglottitis.
- To evaluate the ability of both treatment regimens to eradicate Hib from the throat.
Main Methods:
- A prospective, randomized trial involving 55 children diagnosed with epiglottitis.
- Patients were randomized to receive either a two-day ceftriaxone regimen or a five-day chloramphenicol regimen.
- Hib eradication was assessed via throat swabs four weeks post-discharge.
Main Results:
- No significant differences were observed in fever duration, intubation duration, or hospital admission length between the ceftriaxone and chloramphenicol groups.
- Hib eradication rates at four weeks were similar: 23% for ceftriaxone and 13% for chloramphenicol and rifampicin.
- Ceftriaxone treatment was successful in all patients, with no significant side effects or relapses.
Conclusions:
- A short course of ceftriaxone is a safe, effective, and economical alternative for treating childhood epiglottitis.
- Ceftriaxone demonstrates comparable efficacy to standard chloramphenicol treatment.
- This regimen offers a viable option for managing Hib epiglottitis in children.
Abstract:
Epiglottitis in childhood is caused by Haemophilus influenzae type b. The usual antibiotic treatment at the Royal Children's Hospital, Parkville, Victoria is a five day course of chloramphenicol. Increasingly, third generation cephalosporins are being used to treat invasive H influenzae type b infections and preliminary data suggest that they can be used successfully for epiglottitis. In a prospective, randomised trial, the efficacy of a short course (two days) of ceftriaxone was compared with that of five days of chloramphenicol for the treatment of epiglottitis. The ability of these treatment regimens to eradicate H influenzae type b from the throat was also studied. Fifty five children were enrolled over an 18 month period. Epiglottitis was diagnosed clinically and confirmed on inspection of the epiglottis at direct laryngoscopy. Fifty three (96%) of 55 patients had H influenzae type b detected from at least one site: 44/52 (85%) from blood cultures, 41/47 (87%) from throat swab, and 6/8 (75%) as H influenzae type b urinary antigen. Children were randomised to receive either ceftriaxone 100 mg/kg intravenously followed by a single dose of 50 mg/kg 24 hours later (28 patients), or chloramphenicol 40 mg/kg intravenously, then 25 mg/kg eight hourly for five days, intravenously then by mouth (27 patients). All household contacts and patients receiving chloramphenicol received rifampicin 20 mg/kg daily for four days. Index patients randomised to ceftriaxone were not treated with rifampicin. There was no significant difference in outcome between the two groups with respect to the mean duration of fever, the duration of intubation, or the length of hospital admission. The proportion of patients colonised with H influenzae type b four weeks after discharge was not significantly different between the two groups: ceftriaxone 5/22 (23%) versus chloramphenicol and rifampicin 3/23 (13%). A short course of ceftriaxone was successful in treating all patients with no significant side effects and no relapses. A short course of ceftriaxone is a safe, efficacious, and economic alternative to the standard treatment in children with epiglottitis.