Haemophilus influenzae infection medical therapy
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Haemophilus influenzae infection Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The mainstay of therapy for the majority of infections caused by Haemophilus influenzae is antimicrobial therapy. Epiglottitis is a medical emergency and immediate airway stabilization is necessary. In patients with meningitis, Dexamethasone is administered before the first dose of antimicrobial therapy.
Medical Therapy
Specific parenteral antibiotic treatment is necessary for invasive Hib disease, and immediate airway stabilization is necessary for epiglottitis. Antibiotic prophylaxis with rifampin is indicated for all household contacts in the following circumstances: households with a contact aged 4 years or younger who is unimmunized or underimmunized, households with a child aged younger than 12 months who has not received the primary series, and households with an immunocompromised child. Chemoprophylaxis is not recommended for pregnant women or for child care contacts with a single index case, but the children’s vaccination history should be reviewed to ensure completion of the recommended schedule of Hib conjugate vaccine. A 4-day course of Rifampin eradicates Hib carriage from the pharynx in approximately 95% of carriers.
Antimicrobial regimen
- Haemophilus influenzae[1]
- 1. Non- life threatening infections[2]
- 1.1 Adults
- Preferred regimen (1): Amoxicillin-clavulanate 500 mg PO tid or 875 mg PO bid
- Preferred regimen (2): Amoxicillin 500 mg PO tid
- Preferred regimen (3): TMP-SMX DS PO bid
- Preferred regimen (4): Cefuroxime 250-500 mg PO bid
- Preferred regimen (5): Moxifloxacin 400 mg PO qd
- Preferred regimen (6): Levofloxacin 500 mg PO qd
- Preferred regimen (7): Azithromycin 500 mg PO single dose then 250 mg for 4 days
- Preferred regimen (8): Clarithromycin 500 mg PO bid or XL 500 mg PO q24h
- Note: Treatment duration of otitis media is 10-14 days, acute exacerbation of chronic bronchitis is 5 days (quinolone - 14 days), sinusitis is 10-14 days.
- 2. Meningitis[3]
- Dexamethasone 0.15 mg/kg 15-20 mins before first dose of antibiotic and then q6h for 4 days
- 2.1 Adults
- Preferred regimen (1): Ceftriaxone 2 g IV q12h (4 g maximum)
- Preferred regimen (2): Cefotaxime 2 g IV q4-6h (12 g maximum)
- Preferred regimen (3): Ampicillin 2 g IV q4h if sensitive
- Alternative regimen: Ciprofloxacin 400 mg IV q8h OR other Fluoroquinolones
- 2.2 Pediatric
- 2.2.1 Neonates < 7 days
- 2.2.1.1 Weight < 2 kg
- Preferred regimen: Cefotaxime 50 mg/kg IV q12h for 10-14 days
- 2.2.1.2 Weight > 2 kg
- Preferred regimen (1): Cefotaxime 50 mg/kg IV q8h
- Preferred regimen (2): Ceftriaxone 50 mg/kg IV q24h for 10-14 days
- 2.2.2 Neonates >7 days
- 2.2.2.1 Weight > 2 kg
- Preferred regimen (1): Cefotaxime 50 mg/kg IV q6-8h
- Preferred regimen (2): Ceftriaxone 75 mg/kg IV q24h for 10-14 days
- 2.2.3 Children
- Preferred regimen (1): Cefotaxime 200 mg/kg/day IV q6h
- Preferred regimen (2): Ceftriaxone 100 mg/kg IV q12-24h for 10-14 days
- 2.3 Post-meningitis exposure prophylaxis[4]
- Preferred regimen (1): Rifampin 600 mg PO qd for 4 days
- 3. Severe infections[5]
- 3.1 Adults
- Preferred regimen (1): Ceftriaxone 1-2 g IV q24 or q12h
- Preferred regimen (2): Cefotaxime 2 g IV q6h
- Alternative regimen (1): Ciprofloxacin 400 mg IV q8h or other Fluoroquinolones
- Alternative regimen (2): Ampicillin 2 g IV q6h if sensitive
References
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Centers for Disease Control (CDC) (1982). "Prevention of secondary cases of Haemophilus influenzae type b disease". MMWR Morb Mortal Wkly Rep. 31 (50): 672–4, 679–80. PMID 6819447.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.