Epiglottitis is an acute, life threatening
infection usually caused by Haemophilus influenzae type b. Although
antibiotic therapy is an important part of management, the optimal route and duration is unknown. A multicentre retrospective review of 305 children with
epiglottitis was carried out in order to relate
antibiotic therapy to hospital course and outcome, as well as to examine regional variation in patient demographics, clinical presentation and course of disease. A standardized form was used to extract data from hospital records. Although management varied significantly among the six centres in terms of mean duration of intubation (46 to 81 h), intravenous
antibiotic therapy (3.8 to 5.7 days) and
hospital stay (5.3 to 8.4 days), there were no significant centre-related differences in epidemiology,
clinical course or outcome of
epiglottitis. An extraepiglottic focus of
infection was present in 15% of patients and included three with
septic arthritis and one with
meningitis. The duration of
fever in hospital and maximum recorded temperature in hospital were significantly greater for children with extraepiglottic
infection compared to those with
epiglottitis alone. The data presented in this review suggest that most children with
epiglottitis have an uncomplicated course and respond rapidly to antimicrobial
therapy following airway securement. A short period of intravenous and oral
antibiotic therapy is likely adequate for most children with
epiglottitis. A well designed multicentre prospective trial is still needed to determine the optimal duration of
antibiotic therapy.