Bacterial Tracheitis Treatment & Management
- Author: Sujatha Rajan, MD; Chief Editor: Russell W Steele, MD more...
Treatment of bacterial tracheitis consists of the following:
- 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.
- 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.
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.
The following consultations may be indicated:
- Otorhinolaryngologist - For endoscopic procedures and acute airway management
- Pediatric intensivist - Necessary because of potential for acute decompensation
Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. 2009 Feb. 51(1):110-3. [Medline].
Johnson D. Croup. Clin Evid (Online). 2009 Mar 10. 2009:[Medline].
Holmes A. Croup: What It Is and How to Treat It. US Pharm. 2013. 38(7):47-50.
Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct. 27(10):950-3. [Medline].
Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1. 83(9):1067-73. [Medline].
Tan AK, Manoukian JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol. 1992 Feb. 21(1):48-53. [Medline].
Dawood FS, Chaves SS, Pérez A, Reingold A, Meek J, Farley MM, et al. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. J Infect Dis. 2014 Mar 1. 209(5):686-94. [Medline].
Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. 2009 Apr 28. 1-10. [Medline].
Gallagher PG, Myer CM 3d. An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children. Pediatr Emerg Care. 1991 Dec. 7(6):- Myer CM 3d. [Medline].
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6. [Medline].
Hopkins BS, Johnson KE, Ksiazek JM, et al. H1N1 influenza A presenting as bacterial tracheitis. Otolaryngol Head Neck Surg. 2010 Apr. 142(4):612-4. [Medline].
Mandal A, Kabra SK, Lodha R. Upper Airway Obstruction in Children. Indian J Pediatr. 2015 Aug. 82 (8):737-44. [Medline].
[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. 2004 Mar 26. 53:1-36. [Medline].
Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. 1998 Sep. 27(3):458-62. [Medline].
Brook I. Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care. 1997 Feb. 13(1):16-8. [Medline].
Cherry JD. Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). Textbook of Pediatric Infectious Diseases. 1998. 234-238.
Donnelly BW, McMillan JA, Weiner LB. Bacterial tracheitis: report of eight new cases and review. Rev Infect Dis. 1990 Sep-Oct. 12(5):729-35. [Medline].
Eckel HE, Widemann B, Damm M, Roth B. Airway endoscopy in the diagnosis and treatment of bacterial tracheitis in children. Int J Pediatr Otorhinolaryngol. 1993 Aug. 27(2):147-57. [Medline].
Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. 2003 Mar. 48(3):248-58; discussion 258-60. [Medline].