Bacterial Tracheitis Treatment & Management

  • Author: Sujatha Rajan, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 15, 2010
 

Medical Care

Treatment of bacterial tracheitis consists of the following:

  • Airway
    • Maintenance of an adequate airway is of primary importance.
    • Avoid agitating the child. If the patient's respiratory status deteriorates, it is usually because of movement of the membrane, and bag-valve-mask ventilation should be effective.
    • If intubation is required, use an endotracheal tube 0.5-1 size smaller than expected in order to minimize trauma in the inflamed subglottic area. Frequent suctioning and high air humidity is necessary to maintain endotracheal tube patency; therefore, use the most appropriate-sized tube (without causing trauma). Most patients (57-100%) require eventual intubation.
  • Intravenous access and medication
    • Once the airway is stabilized, obtain intravenous access for initiation of antibiotics.
    • Antibiotic regimens have traditionally included a third-generation cephalosporin (eg, cefotaxime, ceftriaxone) and a penicillinase-resistant penicillin (eg, oxacillin, nafcillin). Recently, clindamycin (40 mg/kg/d intravenously [IV], divided every 8 h) is used instead of penicillinase-resistant penicillin against community acquired–methicillin-resistant S aureus (CA-MRSA) in places where resistance rates of CA-MRSA to clindamycin is low.[8]
    • Vancomycin (45 mg/kg/d IV, divided every 8 h), with or without clindamycin, should be started in patients who appear toxic or have multiorgan involvement or if MRSA is prevalent in the community.
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Surgical Care

Tracheostomy is rarely necessary unless injury or trauma to the airway has caused scarring and documented narrowing of the airway. Tracheostomy is necessary if the patient has failed extubations despite appropriate medical management or if intubation is prolonged. Pulmonary toilet is potentially better with tracheostomy.

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Consultations

The following consultations may be indicated:

  • Otorhinolaryngologist - For endoscopic procedures and acute airway management
  • Pediatric intensivist - Necessary because of potential for acute decompensation
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Contributor Information and Disclosures
Author

Sujatha Rajan, MD  Assistant Professor of Pediatrics, Albert Einstein School of Medicine; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Diseases, Schneider Children's Hospital, North Shore-Long Island Jewish Health System

Sujatha Rajan, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kathryn Clark Emery, MD  Associate Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Consulting Staff, Department of Emergency Medicine, Children's Hospital of Denver

Kathryn Clark Emery, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Sunil K Sood, MBBS, DCh, MD  Professor of Clinical Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine; Chief, Pediatric Infectious Diseases, Firm Director, Pediatric Unit, Schneider Children's Hospital at North Shore, North Shore University Hospital

Sunil K Sood, MBBS, DCh, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: None None None

References

  1. Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. Feb 2009;51(1):110-3. [Medline].

  2. Johnson D. Croup. Clin Evid (Online). Mar 10 2009;2009:[Medline].

  3. Tan AK, Manoukian JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol. Feb 1992;21(1):48-53. [Medline].

  4. Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. Apr 28 2009;1-10. [Medline].

  5. Gallagher PG, Myer CM 3d. An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children. Pediatr Emerg Care. Dec 1991;7(6):- Myer CM 3d. [Medline].

  6. Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. Dec 2004;131(6):871-6. [Medline].

  7. Hopkins BS, Johnson KE, Ksiazek JM, et al. H1N1 influenza A presenting as bacterial tracheitis. Otolaryngol Head Neck Surg. Apr 2010;142(4):612-4. [Medline].

  8. [Best Evidence] Fergie J, Purcell K. The treatment of community-acquired methicillin-resistant Staphylococcus aureus infections. Pediatr Infect Dis J. Jan 2008;27(1):67-8. [Medline]. [Full Text].

  9. [Guideline] Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. Mar 26 2004;53:1-36. [Medline].

  10. Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. Sep 1998;27(3):458-62. [Medline].

  11. Brook I. Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care. Feb 1997;13(1):16-8. [Medline].

  12. Cherry JD. Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). Textbook of Pediatric Infectious Diseases. 1998;234-238.

  13. Donnelly BW, McMillan JA, Weiner LB. Bacterial tracheitis: report of eight new cases and review. Rev Infect Dis. Sep-Oct 1990;12(5):729-35. [Medline].

  14. Eckel HE, Widemann B, Damm M, Roth B. Airway endoscopy in the diagnosis and treatment of bacterial tracheitis in children. Int J Pediatr Otorhinolaryngol. Aug 1993;27(2):147-57. [Medline].

  15. Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. Mar 2003;48(3):248-58; discussion 258-60. [Medline].

 
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