What is bacterial tracheitis and how is it managed in children with croup?

Updated: Oct 09, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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A secondary bacterial infection may result in pneumonia or bacterial tracheitis. Bacterial tracheitis is a life-threatening infection that can arise after the onset of an acute viral respiratory infection. [8, 9, 10, 11] In this clinical scenario, the child usually has a mild to moderate illness for 2-7 days, but then develops severe symptoms. These patients typically have a toxic appearance and do not respond well to nebulized racemic epinephrine (treatment modality for croup). Cases of suspected bacterial tracheitis require hospitalization with close observation, broad-spectrum antibiotics, and, occasionally, endotracheal intubation. Key bacterial pathogens are Staphylococcus aureus including methicillin-resistant strains (MRSA), group A streptococcus (Streptococcus pyogenes), Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenzae, and anaerobes.

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