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 child¹ .
– 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 IV² (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 improved³ 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.

Footnotes

Ref	Notes
1	Critically ill appearing child: weak grunting or crying, drowsiness, difficult to arrouse, does not smile, unconjugate or anxious gaze, pallor or cyanosis, general hypotonia.
2	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	Improvement criteria include: fever reduction, diminished respiratory distress, improved SpO2, improved appetite and/or activity.