Nelson Textbook of Pediatrics 22nd Edition | Acute bacterial infection of trachea, often a complication of viral croup (parainfluenza, influenza). Pathogens: Staphylococcus aureus (most common, including MRSA), group A streptococcus, Streptococcus pneumoniae, Moraxella catarrhalis. Clinical: high fever, toxic appearance, biphasic stridor, thick purulent secretions, pseudomembranes. Diagnosis: direct laryngoscopy/bronchoscopy (normal epiglottis, inflamed trachea with debris). Treatment: airway control (intubation), IV vancomycin + third-generation cephalosporin, rigid bronchoscopy for debridement. Prognosis good with prompt recognition.
🌐 paeds.online — Pakistan's Pediatric Platform| Intervention | Details |
|---|---|
| Airway management | Most require intubation for airway protection and frequent suctioning. Use endotracheal tube (0.5-1 mm smaller). Prepare for rigid bronchoscopy if pseudomembranes obstructing. |
| Antibiotics (empiric) | IV vancomycin (MRSA coverage) + third-generation cephalosporin (ceftriaxone or cefotaxime). Clindamycin alternative if MRSA risk low but anaerobes concern. |
| Bronchoscopy | Rigid bronchoscopy for debridement of thick pseudomembranes if causing obstruction or failed extubation. |
| Supportive care | ICU admission, humidified oxygen, IV fluids, frequent suctioning (via endotracheal tube). Avoid racemic epinephrine (ineffective). |
| Extubation criteria | Resolution of fever, decreased secretions, air leak around tube, direct visualization of improved airway. Typically 3-7 days. |