Bacterial tracheitis

Bacterial infection of the trachea in children, occurring as a complication of a previous viral infection (croup, influenza, measles, etc.).

Clinical features

• Fever in a critically ill appearing child a Citation a. Critically ill appearing child: weak grunting or crying, drowsiness, difficult to arrouse, does not smile, unconjugate or anxious gaze, pallor or cyanosis, general hypotonia. .
• Stridor, cough and respiratory distress.
• Copious purulent secretions.
• As opposed to epiglottitis the onset of symptoms is gradual and the child prefers to lie flat.
• In severe cases there is a risk of complete airway obstruction, especially in very young children.

Treatment

• Suction purulent secretions.
• Insert a peripheral IV line and provide IV hydration.
• Antibiotherapy:
  ceftriaxone slow IV b Citation b. For administration by IV route, ceftriaxone powder should to be reconstituted in water for injection only. For administration by IV infusion, dilute each dose of ceftriaxone in 5 ml/kg of 0.9% sodium chloride or 5% glucose in children less than 20 kg and in a bag of 100 ml of 0.9% sodium chloride or 5% glucose in children over 20 kg and in adults. (3 minutes) or IV infusion (30 minutes). Do not administer by IM route (may agitate the child and precipitate a respiratory arrest).
  Children: 50 mg/kg once daily
  Adults: 1 g once daily
  +
  cloxacillin IV infusion (60 minutes)
  Children less than 12 years: 25 to 50 mg/kg every 6 hours
  Children 12 years and over and adults: 2 g every 6 hours
  The IV treatment is administered for at least 5 days then, if the clinical condition has improved c Citation c. Improvement criteria include: fever reduction, diminished respiratory distress, improved SpO₂, improved appetite and/or activity. and oral treatment can be tolerated, change to :
  amoxicillin/clavulanic acid (co-amoxiclav) PO to complete 7 to 10 days of treatment, as in epiglottitis.
• If the event of complete airway obstruction, intubation if possible or emergency tracheotomy.