Acute Bacterial Tracheitis
Acute bacterial tracheitis
General and supportive measures
ICD-10 code: J04.1
DESCRIPTION
An acute infective process characterised by marked subglottic oedema, with ulceration, erythema, pseudomembranous formation on the tracheal surface, and thick, mucopurulent secretions that frequently obstructs the lumen. Commonly due to S. aureus.
DIAGNOSTIC CRITERIA
Clinical
- Severely ill and toxic with airway obstruction and respiratory distress.
- Insidious onset, brassy cough, neck pain, dysphagia, no drooling.
- Associated co-infection, e.g. pneumonia.
Investigations
- Raised white cell count with left shift.
- Lateral neck X-ray: hazy tracheal air column.
- Upper airway endoscopy.
- Bacterial cultures on blood and pharyngeal secretions.
GENERAL AND SUPPORTIVE MEASURES
- Intubate and suction secretions if features of severe upper airway obstruction are present.
- Mechanical ventilation if associated pneumonia present.
MEDICINE TREATMENT
- Ceftriaxone, IV, 80 mg/kg once daily.
OR
If one month old or younger:
- Cefotaxime, IV, 50 mg/kg/dose, 6–8 hourly.
Adjust antibiotics according to sensitivity results.
For pain and fever:
- Paracetamol, oral, 15 mg/kg/dose 6 hourly.
Give 3 doses of corticosteroids to intubated patients prior to extubation:
- Dexamethasone, IV, 0.15 mg/kg/dose 8 hourly.
REFERRAL
- All cases requiring intubation.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 17: Ear Nose & Throat, 17.3 Tonsillitis, Complicated (Peritonsillar Cellulitis, Peritonsillar Abscess), 17.3.1 Acute Bacterial Tracheitis