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.