Bacterial tracheitis in children: Approach to diagnosis and treatment

Bacterial tracheitis is due to a secondary bacterial infection of the trachea, resulting in the formation of mucopurulent exudates that may acutely obstruct the upper airway, resulting in a life-threatening condition. Bacterial tracheitis should be considered in the differential diagnosis of any child with acute upper airway obstruction. This diagnosis should also be considered in any child with viral croup that is nonresponsive to conventional therapy. The only definitive way to diagnose bacterial tracheitis is by direct visualization of the trachea via bronchoscopy; however, this may not be required in all cases. Management includes close observation and monitoring, early initiation of broad spectrum antibiotics, pain management and aggressive airway clearance techniques. The decision to intubate should be individualized based on the severity of symptoms, age of child and accessibility of personnel skilled at emergency intubation techniques. If diagnosed and treated early, complete recovery is expected.