How is bacterial tracheitis treated?

Updated: Nov 26, 2018
  • Author: Sujatha Rajan, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Treatment of bacterial tracheitis consists of the following:

  • Airway

    • Maintenance of an adequate airway is of primary importance. [12]

    • 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. [13]

    • 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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