Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

652 Haemophilus Infections

differential diagnosis

■Must distinguish syndromes from those caused by other bacteria

(can only do by culture) or viruses; no clinical criteria allow reliable

determination of specific microbial etiology

management

■General supportive measures for syndromes as needed: meningi-

tis – decrease intracranial pressure if >20 mmHg with mannitol or

hyperventilation, support blood pressure; epiglottitis – maintain air-

way patency; pneumonia – supplemental oxygen, drain empyema;

bacteremia – support blood pressure; septic arthritis – drain joint

specific therapy

■Invasive Hib infection can be rapidly progressive and life-

threatening; meningitis treated with third-generation cephalosporin

(ceftriaxone IV or cefotaxime IV) for 7–10 days; epiglottitis and bac-

teremia treated similarly, but ceftriaxone every 24 hours; endocardi-

tis treated with ceftriaxone for 4 weeks; up to one third of strains

produce beta-lactamase, thus making ampicillin an inappropriate

drug for therapy of serious, life-threatening infections; in severely

penicillin-allergic patient (anaphylaxis) alternatives include desen-

sitization or use of chloramphenicol, fluoroquinolones or aztreonam

■Infections due to nontypable strains (sinusitis, otitis, exacerba-

tions of chronic bronchitis) usually treated with oral drugs; doxycy-

cline, amoxicillin, trimethoprim-sulfamethoxazole commonly used;

other agents with activity include amoxicillin-clavulanate, fluo-

roquinolones, newer macrolides (azithromycin, clarithromycin),

extended spectrum cephalosporins (cefuroxime, cefpodoxime, cef-

prozil)

follow-up

■Follow-up as for the syndrome treated

complications and prognosis

■See specific syndromes for complications and prognosis.

■Conjugate vaccines against invasive type B disease very effective

in infants and children; not studied in adults, but immunization

of highly susceptible adults (asplenia, hypogammaglobulinemia)

should be considered

■Chemoprophylaxis with rifampin is recommended for all household

contacts, including adults, if there is a case of invasive Haemophilus

type B disease and immunization of children <4 y of age living in