Patients with acute epiglottitis who also have sepsis, concomitant meningitis, or who reside in areas with elevated clindamycin-resistant MRSA prevalence represent a distinct clinical subpopulation requiring a modified approach to empiric antibiotic selection.
Any of the following defines this patient group: epiglottitis complicated by sepsis, concomitant meningitis, or residence in an area with an increased prevalence of clindamycin-resistant methicillin-resistant Staphylococcus aureus. These factors directly determine which antistaphylococcal agent is the preferred choice in the empiric regimen.
Immediate airway management is the first priority. Empiric combination antibiotic therapy is initiated, with the antistaphylococcal agent specifically selected based on this patient group. Adjuvant supportive measures are included alongside antimicrobials.
The complete regimen — specific agents, sequencing, adjuvants, and the full decision algorithm — is in the structured protocol.
Edema typically improves within 2 to 3 days of initiating antimicrobial treatment. Extubation criteria include resolution of fever, odynophagia/dysphagia symptoms, and airway edema, assessed by nasolaryngoscopy or a positive cuff leak test.
DOI: 10.2344/anpr-66-04-08