From the Research
The recommended duration of therapy for bacterial tracheitis is typically 10 to 14 days of appropriate antibiotics, as seen in a study where all patients were transitioned to oral antibiotic therapy for 10 to 14 days after discharge 1.
Key Considerations
- Initial treatment often includes intravenous antibiotics such as ceftriaxone or ampicillin-sulbactam, followed by oral antibiotics once clinical improvement occurs.
- Common oral options include amoxicillin-clavulanate or cefuroxime, and treatment should target common pathogens like Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae.
- Patients should continue antibiotics for the full course even if symptoms improve earlier to ensure complete eradication of the infection and prevent recurrence.
- Supportive care is also essential, including adequate hydration, humidified oxygen if needed, and airway management.
Duration of Therapy
- The duration of therapy may be extended in immunocompromised patients or those with persistent symptoms.
- A study found that prolonged-course antibiotics were not protective against progression to hospital-acquired pneumonia or ventilator-associated pneumonia, and were associated with a significantly increased risk of subsequent multidrug-resistant organism acquisition 2.
- Another study compared azithromycin and co-amoxiclav in the treatment of acute tracheobronchitis and acute infectious exacerbations of chronic bronchitis, and found that azithromycin produced a significantly higher cure rate and fewer failures and relapses 3.
Recent Guidelines
- A literature review summarized the microbiological and clinical aspects of community-acquired and nosocomial tracheitis in adults and children, and highlighted the emergence of fungal tracheitis in immunocompromised patients and ventilator-associated tracheitis in intensive care medicine 4.
- The review also emphasized the importance of early disease identification and urgent surgical intervention in the management of bacterial tracheitis, as seen in a study where all patients did well with aggressive medical management and none required urgent intubation or tracheotomy 1.