Initial drug of choice in a child with status epilepticus

Prompt treatment with benzodiazepines is the first-line treatment of status epilepticus, but many patients will need additional treatment with additional medications including phenytoin, valproic acid, phenobarbital, or levetiracetam. The Neurocritical Care Society's guideline states that benzodiazepines remain the "emergent initial therapy" of choice based both on available evidence and expe consensus. When possible, intravenous benzodiazepine administration is preferred. However, formulations exist for buccal, intranasal, intramuscular, and rectal administration, and these should be administered if intravenous access cannot be rapidly established. The American Epilepsy Society's guideline concludes that intravenous lorazepam and diazepam are efficacious at stopping seizures lasting at least five min and that rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective at terminating seizures lasting at least five minutes . Reference: GHAI Essential pediatrics, 8th edition