The antibiotic of choice in acute epiglottitis pending culture sensitivity report is: (LQ)
Ref. Turner 1 Oth/ed p 390
Well friends, there is some controversy over this one.
• Let's, first see what Dhingra 51e, p 308, has to say:
• Ampicillin or third generation cephalosporin are effective against H. influenzae and are given by parenteral route." However, books like Turner and Harrison do not agree with Dhingra about ampicillin being the drug of choice. Harrison 17 Ie, p 212 says:
"Once the airway has been secured and specimens of blood and epiglottis tissue have been obtained for cultrue. treatment with IV antibiotics should be given to cover the most likely organism particularly H. influenzae. Because rates of ampicillin resistance in this organism have risen significantly in recent years, therapy with a beta lactam I beta lactamase inhibitor combination or a second or third generation cephalosporin is recommended. Typically, ampicillin I sulbactam, cefuroxime, cefotaxime or ceftriaxone is given, with c/indamycin and trimethoprim-sulfamethoxazole reserved for patients allergic to beta lactams"
So, according to Harrison DOC are:
a. Ampicillin + Sulbactam (Not ampicillin alone)
According to Scott's Brown 71ed vol-2 pg-2251
"The antibiotics of choice are second and third generation cephalosporin. Ampicillin was often prescribed but resistant H.influenza are now emerging':
Now, lets read what Turner 10th ed, p 390 has to say:
'Treatment is to put the child in an atmosphere of moist oxygen. Sedation must be given cautiously, if at all, in case the respiratory centre is depressed.Chloramphenicol is the antibiotic of choice and it should be given intramuscularly or preferably intravenously. Amoxycillin or ampicillin is no longer advised as haemophilus organism are now sufficiently often resistant to make its use inappropirate."
Neither 2nd/3rd generation cephalosporins nor chloramphenicol is give in the option. Hence we will have to opt for amplicillin as no other opiton is correct.
Remember: DOC for epiglottitis -2nd/3rd generation cephalosporin. Treatment with amplicillin is not that effective due to b lactamase production by Hib. Prophylaxis with Rifampicin for 4 days is advocated in unimmunized household contacts < 4 years of age and in all immunocompromised contact.