- Support by stabilizing airway, breathing, circulation (ABCs)
- Maintain airway
- Initiate IV, O2, and monitor
- Rapid assessment of ABCs is essential with emphasis on airway control.
- Supplemental oxygen is usually needed.
- Anticipate and prepare for emergent endotracheal intubation and tracheostomy.
- Endoscopy with suctioning and debridement is often necessary for diagnosis and therapy.
- Subsequent airway suctioning and monitoring prevents adverse outcomes.
- Increased ventilatory support is often required for children with pre-existing artificial airways.
NPO until airway stabilized and patient is able to tolerate oral foods.
- Suction secretions
- Monitor closely
Select antibiotic therapy based on gram stain and culture results of tracheal secretions. Also consider known prior colonization and institutional pathogens in children with pre-existing artificial airway and hospital-acquired infections.
- Mild illness:
- Empiric therapy with amoxicillin–clavulanic acid or a 2nd-generation cephalosporin for 10–14 days (25–45 mg/kg per 24 hours depending on the antibiotic used)
- Consider a semisynthetic penicillin such as dicloxacillin (15–25 mg/kg per 24 hours) if H. influenzae type B vaccine completed and clindamycin (10–30 mg/kg per 24 hours) if presence of a penicillin allergy
- Moderate to severe illness:
- Empiric therapy with a 2nd- or 3rd-generation cephalosporin or with ampicillin–sulbactam
- Consider vancomycin (40 mg/kg per 24 hours) if a hospital-acquired infection is present or if pneumococcal resistance is suspected.
- Anaerobic, pseudomonas, and other Gram-negative coverage should be considered in children not responding to initial therapy or having pre-existing artificial airways.
- In contrast to croup, nebulized racemic epinephrine does not provide significant relief.
- Duration: Based on clinical response; usually 10–14 days