Bacterial tracheitis is a condition characterized by profuse exudates and pseudomembranes due to severe bacterial infection of the trachea. It can occur as a primary bacterial infection or following a viral illness. The most common manifestation is stridor in young children. Bacterial tracheitis is similar to viral croup and epiglottitis; however, affected individuals typically have higher fevers, are ill-appearing, and have severe respiratory symptoms that do not respond to treatments (e.g., with nebulized epinephrine). Patients usually require immediate stabilization and airway management before proceeding to bronchoscopy for diagnostic confirmation and treatment. Additional treatment includes broad-spectrum antibiotics and ICU management. If left untreated, bacterial tracheitis may progress to complete airway obstruction, sepsis, and death.
- Preceding viral upper respiratory tract infection: productive cough, hoarseness, sore throat 
- Severe rapidly progressing symptoms (within 2–10 hours) 
- Initiate immediate stabilization for unstable patients.
- Give empiric IV antibiotics.
- Urgently consult ENT for direct visualization; bronchoscopy confirms the diagnosis and can treat airway obstruction.
- Consider supportive studies to rule out .
- Admit to ICU for further management. 
Do not delay treatment to obtain diagnostic studies.
Immediate stabilization 
- Signs of airway compromise: Provide .
- : Provide .
Medical therapy 
- Empiric IV antibiotics with antistaphylococcal cover, e.g., ceftriaxone ; PLUS vancomycin 
- Supportive treatment (e.g., antipyretics, IV fluids) as needed
- Consider glucocorticoids to reduce airway edema. 
Direct visualization 
- Modalities: bronchoscopy, flexible laryngoscopy 
- Findings include: 
Supportive studies 
- Laboratory studies 
- Imaging 
- See “ .”
The differential diagnoses listed here are not exhaustive.
Acute management checklist for bacterial tracheitis
- Immediately initiate respiratory support.
- Consider intubation; patients will have a difficult airway.
- Give empiric IV antibiotics (e.g., ceftriaxone and vancomycin).
- Start supportive therapy (antipyretics, IV fluids).
- Urgently consult ENT for bronchoscopy to confirm the diagnosis and debride the trachea.
- Admit to the ICU.