LAB WORK
TREATMENT
CLINICAL NOTES
- G(-), encapsulated organism (six different capsules; type "b" crucial for virulence, allows organism to enter the bloodsteam, hence abbreviation "HIB", Haemophilus infleunza type b)
TREATMENT
- Divided according to whether this is HIB or other HI ("non-typeable")
- A third of HI strains produce beta lactamase, so aminopenicillins like ampicillin or amoxicillin should only be used if sensitivity is confirmed!
- Non-Typeable HI (typically cause mucosal infections, OM, COPD exacerbations, sinusitis, conjunctivitis, CAP)
- Mild (Note: the agents below also cover Strep. pneumo and Moraxella)
- Augmentin
- Respiratory FQ (levofloxacin, moxifloxacin)
- Macrolides (azithromycin, clarithromycin)
- Extended spectrum oral cephalosporins (cefixime, cefpodoxime)
- Severe
- Rocephin
- Unasyn
- Fluoroquinolones IV
- Azithromycin IV
- Mild (Note: the agents below also cover Strep. pneumo and Moraxella)
- HI Type B (associated with invasive infections, meningitis, epiglottitis, PNA, bacteremia, septic arthritis)
- First line: Ceftriaxone or Cefotaxime
- Duration: 7-10 days, continue treatment until afebrile and asymptomatic for 3-5 days
- For meningitis, adding dexamethasone course x 4 days associated with decreased incidence of neurological symptoms in children
- If administering, give 15-20 minutes before FIRST dose of antibiotic
- First line: Ceftriaxone or Cefotaxime
- Non-Typeable HI (typically cause mucosal infections, OM, COPD exacerbations, sinusitis, conjunctivitis, CAP)
CLINICAL NOTES
- Chemoprophylaxis
- In absence of immunization, household contacts of individuals with invasive HIB who are under 4 years of age are at increased risk, so prophylaxis with rifampin x 4 days is recommended in 2 groups within 7 days of exposure:
- For all household members including adults (except for pregnant women) where there's been contact by a member under 4 years of age and whose immunization status with the HIB vaccine is incomplete OR an immunocompromised child of any age.
- For all attendees and personnel at daycare centers/nurseries when 2 or more cases of invasive HIB have occurred within 60 days if incompletely immunized children attend the facility
- In absence of immunization, household contacts of individuals with invasive HIB who are under 4 years of age are at increased risk, so prophylaxis with rifampin x 4 days is recommended in 2 groups within 7 days of exposure:
- Immunization for HIB is available, conjugate HIB vaccines (ACTHIB, PedvaxHIB) which all children should be vaccinated with (series) starting at 2 months of age.