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 aCitation 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 bCitation 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 cCitation 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.