eMedicine Specialties > Infectious Diseases > Bacterial Infections
Moraxella Catarrhalis Infections: Treatment & Medication
Updated: Nov 17, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Medical care of M catarrhalis infection depends on the infection site, age of the patient, underlying condition(s), and severity of the disease.
Consultations
- Consultation with an ear, nose, and throat specialist may be indicated in recurrent cases of otitis or sinusitis.
- Consultation with an infectious disease specialist is recommended for infections that do not respond to antibiotic treatment, infections in patients with underlying debilitating conditions, systemic infections with M catarrhalis, or infections in unusual locations.
Medication
Approximately 95% of M catarrhalis strains isolated in the United States produce beta-lactamase. Antibiotics such as penicillin, amoxicillin, and ampicillin are only effective against strains that do not produce beta-lactamase.
Topical ciprofloxacin/dexamethasone treatment for acute otitis media with otorrhea via tympanostomy tubes was found to have similar efficacy to that of topical ofloxacin in M catarrhalis infections.17
Treatment with oral azithromycin 500 mg once daily for 3 days was found comparable with a 10-day regimen of oral clarithromycin 500 mg twice daily in the treatment of acute exacerbation of chronic bronchitis.18
Telithromycin, a ketolide derivative of erythromycin A, demonstrated good in vitro activity against M catarrhalis in acute exacerbation of chronic bronchitis.19 However, severe liver disease associated with telithromycin use has been reported.20
The below antimicrobial drugs may be used in M catarrhalis infections, depending on the need for use of oral or parenteral medication, patient's age, underlying condition, sensitivity of the organism, and desired spectrum of coverage.
Antimicrobials
Therapy should cover likely pathogens in the context of this clinical setting. Nearly all M catarrhalis strains produce beta-lactamase.
Amoxicillin-clavulanate, second- and third-generation oral cephalosporins, and trimethoprim-sulfamethoxazole (TMP-SMX) are the most recommended agents. Alternatively, azithromycin, clarithromycin, or dirithromycin can be used. More than 90% of M catarrhalis strains have been shown to resist amoxicillin, and these rates vary by region.21 All other agents listed below are also effective.
Erythromycin (E.E.S., E-Mycin, Ery-Tab)
Recommended dosing schedule of erythromycin may result in GI upset, causing one to prescribe an alternative macrolide or change to tid dosing. Covers most potential etiologic agents, including Mycoplasma species.
Although 10 d seems to be a standard course of treatment, treating until the patient has been afebrile for 3-5 d seems a more rational approach. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.
Has the added advantage of being a good anti-inflammatory agent by inhibiting migration of polymorphonuclear leukocytes.
Adult
500 mg (base, estolate, stearate) PO q6h or 400 mg (ethylsuccinate) PO q6h
Pediatric
20-50 mg/kg/d PO divided q6h
Inhibits CYP450 1A2, 3A3/4 isoenzymes; coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis; decreases metabolism of repaglinide, thus increasing serum levels and effects
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Cefaclor (Ceclor)
Second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Determine proper dosage and route based on condition of patient, severity of infection, and susceptibility of causative organism.
Adult
500 mg PO q8h
Pediatric
20-40 mg/kg/d PO divided q8-12h; not to exceed 2 g/d
Alcoholic beverages consumed <72 h after taking cefaclor may produce disulfiramlike reactions; may increase hypoprothrombinemic effects of anticoagulants; coadministration with potent diuretics and aminoglycosides (eg, loop diuretics) may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reduce dosage by half if CrCl is 10-30 mL/min and by three fourths if <10 mL/min (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy; adjust dose in severe renal insufficiency; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Cefprozil (Cefzil)
Binds to 1 or more of the penicillin-binding proteins, which in turn inhibits cell wall synthesis and results in bactericidal activity.
Adult
500 mg PO qd
Pediatric
<12 years: 7.5-15 mg/kg/d PO divided q12h for 10 d
>12 years: Administer as in adults
Probenecid increases effect of cefprozil; coadministration with furosemide and aminoglycosides increases nephrotoxic effects of cefprozil
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Cefuroxime (Ceftin, Kefurox, Zinacef)
Second-generation cephalosporin maintains gram-positive activity that first-generation cephalosporins have; adds activity against Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and M catarrhalis. Condition of patient, severity of infection, and susceptibility of microorganism determine proper dose.
Adult
500 mg PO q12h
Pediatric
Children: 250 mg PO bid for 20 d
Adolescents: Administer as in adults
Disulfiramlike reactions may occur when alcohol is consumed within 72 h after taking cefuroxime; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics such as loop diuretics; coadministration with aminoglycosides increases nephrotoxic potential
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Administer half dose if CrCl is 10-30 mL/min and quarter dose if <10 mL/min; fungal and microorganism overgrowth may occur with prolonged therapy
Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMX includes common urinary tract pathogens, except Pseudomonas aeruginosa.
Adult
160 mg TMP/800 mg SMX PO q12h
Pediatric
<2 months: Do not administer
>2 months: 15-20 mg/kg/d PO tid/qid for 14 d, based on TMP
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue at first appearance of rash or sign of adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, persons with chronic alcoholism, elderly persons, those receiving anticonvulsant therapy, or those with malabsorption syndrome); hemolysis may occur in G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
Cefotaxime (Claforan)
For septicemia and treatment of gynecologic infections caused by susceptible organisms. Arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth. Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms.
Adult
Moderate-to-severe infections: 2 g IV q6h
Pediatric
Infants and children: 50-180 mg/kg/d IV/IM divided q4-6h
>12 years: Administer as in adults
Probenecid may increase cefotaxime levels; coadministration with furosemide and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal impairment; has been associated with severe colitis
Ceftriaxone (Rocephin)
Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.
Adult
Moderate-to-severe infections: 1-2 g IV q12-24h; not to exceed 4 g/d
Pediatric
Neonates >7 days: 25-50 mg/kg/d IV/IM; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV/IM divided q12h; not to exceed 2 g/d
Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; caution with breastfeeding; caution with allergy to penicillin
Cefoperazone (Cefobid)
Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Presence of piperazine side chain makes it structurally different from other cephalosporins and enhances antipseudomonal activity. Gram-negative spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism.
Adult
2 g IV q12h
Pediatric
Children and infants: 100-150 mg/kg/d IV/IM divided bid/tid; not to exceed 12 g/d
Adolescents: Administer as in adults
Nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid; probenecid may increase cefoperazone levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May increase protime
Ceftazidime (Ceptaz, Fortaz)
Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Gram-negative spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism.
Adult
2 g IV q8h; not to exceed 6 g/d
Pediatric
Children and infants: 30-50 mg/kg IV q8h; not to exceed 6 g/d
Adolescents: Administer as in adults
Nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid; probenecid may increase ceftazidime levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Ceftizoxime (Cefizox)
Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Gram-negative spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism.
Adult
2 g IV q8h; not to exceed 12 g/d
Pediatric
Children and infants >6 months: 50 mg/kg IV/IM q6-8h; not to exceed 12 g/d
Adolescents: Administer as in adults
Nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid; probenecid may increase ceftizoxime levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal insufficiency; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Ciprofloxacin (Cipro)
Fluoroquinolone with activity against most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis, and consequently, growth.
Adult
500 mg PO q12h
Pediatric
<18 years: Not recommended
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause seizures; avoid in renal insufficiency and in patients with CNS disorders
Levofloxacin (Levaquin)
For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.
Adult
500 mg PO qd
Pediatric
<18 years: Not recommended
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, periodically evaluate organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may develop with prolonged or repeated antibiotic therapy
Azithromycin (Zithromax)
Treats mild-to-moderate microbial infections
Adult
500 mg PO on day 1; followed by 250 mg PO qd on days 2-5
Pediatric
<6 months: Not established
>6 months: 10 mg/kg PO once on day 1; not to exceed 500 mg/d, followed by 5 mg/kg PO qd on days 2-5; not to exceed 250 mg/d
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals; caution in hospitalized, geriatric, or debilitated patients
Clarithromycin (Biaxin)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
500 mg PO q12h
Pediatric
15 mg/kg PO divided bid
Toxicity increases with coadministration of fluconazole and pimozide; clarithromycin effects decrease and adverse GI effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
Documented hypersensitivity; coadministration of pimozide
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies
Dirithromycin (Dynabac)
Not available in the United States. Inhibits RNA-dependent protein synthesis by binding to 50S ribosomal subunit. Antimicrobial spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism. Dosage depends on severity of infection and susceptibility of organism. In children, age, weight, and severity of infection determine proper dosage.
Adult
500 mg PO qd; administer with meal
Pediatric
Not established
May increase serum digoxin levels; may increase risk of ergot toxicity with ergotamine or dihydroergotamine
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Associated with GI distress, pseudomembrane colitis, dizziness, headache, insomnia, pruritus
More on Moraxella Catarrhalis Infections |
| Overview: Moraxella Catarrhalis Infections |
| Differential Diagnoses & Workup: Moraxella Catarrhalis Infections |
 Treatment & Medication: Moraxella Catarrhalis Infections |
| Follow-up: Moraxella Catarrhalis Infections |
| References |
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Further Reading
Keywords
Moraxella catarrhalis, Neisseria catarrhalis, N catarrhalis, Micrococcus catarrhalis, M catarrhalis, Branhamella catarrhalis, B catarrhalis, upper respiratory tract infections, lower respiratory tract infections, otitis media, sinusitis, chronic obstructive pulmonary disease, COPD, pneumonia, Moraxella catarrhalis infection, M catarrhalis infection, M catarrhalis endocarditis, M catarrhalis pneumonia, M catarrhalis otitis media, M catarrhalis sinusitis, M catarrhalis bacteremia, Moraxella catarrhalis endocarditis , Moraxella catarrhalis pneumonia , Moraxella catarrhalis otitis media , Moraxella catarrhalis sinusitis , Moraxella catarrhalis bacteremia
