Moraxella catarrhalis Infection Treatment & Management
- Author: Michael Constantinescu, MD; Chief Editor: Michael Stuart Bronze, MD more...
Medical management of M catarrhalis infection depends on the infection site, age of the patient, underlying condition(s), and severity of the disease.
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.
Follow-up care with the patient’s primary care physician is highly recommended. Worsening symptoms warrant a return visit to the primary care physician.
Any of a number of antimicrobial drugs may be used to treat M catarrhalis infection, depending on the need for use of oral or parenteral medication, the age of the patient, any underlying conditions present, the sensitivity of the organism, and the desired spectrum of coverage.
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.
Amoxicillin-clavulanate, second- and third-generation oral cephalosporins, and trimethoprim-sulfamethoxazole (TMP-SMZ) are the most recommended agents. Alternatively, azithromycin or clarithromycin can be used. More than 90% of M catarrhalis strains have been shown to resist amoxicillin, and these rates vary by region.
In one study, topical use of ciprofloxacin/dexamethasone for treatment of acute otitis media with otorrhea via tympanostomy tubes was found to have similar efficacy to that of topical use of ofloxacin in M catarrhalis infections.
In another study, treatment with oral azithromycin 500 mg once daily for 3 days was found to be comparable with a 10-day regimen of oral clarithromycin 500 mg twice daily for the treatment of acute exacerbation of chronic bronchitis.
Telithromycin, a ketolide derivative of erythromycin A, demonstrated good in vitro activity against M catarrhalis in a study of patients with acute exacerbations of chronic bronchitis. However, severe liver disease associated with telithromycin use has been reported.
Moxifloxacin, a quinolone, was found to be an effective treatment of M catarrhalis– associated community-acquired pneumonia in a dosage of 400 mg/day.
Universal precautions, good hand-washing technique, and sterilization of instruments and tubes used in intubations, aspiration, or invasive procedures may reduce or prevent the nosocomial infections caused by M catarrhalis. Cessation of smoking and prevention of passive smoking may reduce M catarrhalis infections. Good general health habits (eg, proper rest, exercise, and diet) are helpful as well.
Research is under way to create a vaccine to prevent M catarrhalis infections.[26, 27] It is projected that 4.2 million episodes of otitis media would be prevented by a combined pneumococcal-nontypeable H influenzae–Moraxella vaccine.
Aebi C. Moraxella catarrhalis - pathogen or commensal?. Adv Exp Med Biol. 2011. 697:107-16. [Medline].
Wright PW, Wallace RJ Jr, Shepherd JR. A descriptive study of 42 cases of Branhamella catarrhalis pneumonia. Am J Med. 1990 May 14. 88(5A):2S-8S. [Medline].
Pappas DE, Hendley JO, Hayden FG, Winther B. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J. 2008 Jan. 27(1):8-11. [Medline].
Gehanno P, Panajotopoulos A, Barry B, Nguyen L, Levy D, Bingen E, et al. Microbiology of otitis media in the Paris, France, area from 1987 to 1997. Pediatr Infect Dis J. 2001 Jun. 20(6):570-3. [Medline].
Li WC, Chiu NC, Hsu CH, Lee KS, Hwang HK, Huang FY. Pathogens in the middle ear effusion of children with persistent otitis media: implications of drug resistance and complications. J Microbiol Immunol Infect. 2001 Sep. 34(3):190-4. [Medline].
Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci. 1998 Jul. 316(1):13-20. [Medline].
Hunter MH, King DE. COPD: management of acute exacerbations and chronic stable disease. Am Fam Physician. 2001 Aug 15. 64(4):603-12. [Medline].
Lieberman D, Lieberman D, Ben-Yaakov M, et al. Infectious etiologies in acute exacerbation of COPD. Diagn Microbiol Infect Dis. 2001 Jul. 40(3):95-102. [Medline].
Sethi S, Murphy TF. Bacterial infection in chronic obstructive pulmonary disease in 2000: a state-of-the-art review. Clin Microbiol Rev. 2001 Apr. 14(2):336-63. [Medline]. [Full Text].
Soler N, Torres A, Ewig S, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med. 1998 May. 157(5 Pt 1):1498-505. [Medline].
Aronovitz G. Treatment of upper and lower respiratory tract infections: clinical trials with cefprozil. Pediatr Infect Dis J. 1998 Aug. 17(8 Suppl):S83-8. [Medline].
Manfredi R, Nanetti A, Valentini R, Chiodo F. Moraxella catarrhalis pneumonia during HIV disease. J Chemother. 2000 Oct. 12(5):406-11. [Medline].
Thórsson B, Haraldsdóttir V, Kristjánsson M. Moraxella catarrhalis bacteraemia. A report on 3 cases and a review of the literature. Scand J Infect Dis. 1998. 30(2):105-9. [Medline].
Neumayer U, Schmidt HK, Mellwig KP, Kleikamp G. Moraxella catarrhalis endocarditis: report of a case and literature review. J Heart Valve Dis. 1999 Jan. 8(1):114-7. [Medline].
Stefanou J, Agelopoulou AV, Sipsas NV, Smilakou N, Avlami A. Moraxella catarrhalis endocarditis: case report and review of the literature. Scand J Infect Dis. 2000. 32(2):217-8. [Medline].
Narinesingh SP, Whitby DJ, Davenport PJ. Moraxella catarrhalis: an unrecognized pathogen of the oral cavity?. Cleft Palate Craniofac J. 2011 Jul. 48(4):462-4. [Medline].
Tritton D, Watts T, Sieratzki JS. Peri-orbital cellulitis and sepsis by Branhamella catarrhalis. Eur J Pediatr. 1998 Jul. 157(7):611-2. [Medline].
Abdolrasouli A, Amin A, Baharsefat M, Roushan A, Hemmati Y. Moraxella catarrhalis associated with acute urethritis imitating gonorrhoea acquired by oral-genital contact. Int J STD AIDS. 2007 Aug. 18(8):579-80. [Medline].
Uehara Y, Yagoshi M, Tanimichi Y, Yamada H, Shimoguchi K, Yamamoto S, et al. Impact of reporting gram stain results from blood culture bottles on the selection of antimicrobial agents. Am J Clin Pathol. 2009 Jul. 132(1):18-25. [Medline]. [Full Text].
Hwang PH. A 51-year-old woman with acute onset of facial pressure, rhinorrhea, and tooth pain: review of acute rhinosinusitis. JAMA. 2009 May 6. 301(17):1798-807. [Medline].
Roland PS, Kreisler LS, Reese B, et al. Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic solution in the treatment of children with acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. 2004 Jan. 113(1 Pt 1):e40-6. [Medline]. [Full Text].
Swanson RN, Lainez-Ventosilla A, De Salvo MC, Dunne MW, Amsden GW. Once-daily azithromycin for 3 days compared with clarithromycin for 10 days for acute exacerbation of chronic bronchitis: a multicenter, double-blind, randomized study. Treat Respir Med. 2005. 4(1):31-9. [Medline].
Sethi S, Anzueto A, Farrell DJ. Antibiotic activity of telithromycin and comparators against bacterial pathogens isolated from 3,043 patients with acute exacerbation of chronic bronchitis. Ann Clin Microbiol Antimicrob. 2005 Mar 8. 4:5. [Medline]. [Full Text].
Dore DD, DiBello JR, Lapane KL. Telithromycin use and spontaneous reports of hepatotoxicity. Drug Saf. 2007. 30(8):697-703. [Medline].
Yoshida K, Okimoto N, Kishimoto M, et al. Efficacy and safety of moxifloxacin for community-acquired bacterial pneumonia based on pharmacokinetic analysis. J Infect Chemother. 2011 Oct. 17(5):678-85. [Medline].
Ren D, Yu S, Gao S, et al. Mutant lipooligosaccharide-based conjugate vaccine demonstrates a broad-spectrum effectiveness against Moraxella catarrhalis. Vaccine. 2011 Jun 6. 29(25):4210-7. [Medline]. [Full Text].
Yang M, Johnson A, Murphy TF. Characterization and evaluation of the Moraxella catarrhalis oligopeptide permease A as a mucosal vaccine antigen. Infect Immun. 2011 Feb. 79(2):846-57. [Medline]. [Full Text].
O'Brien MA, Prosser LA, Paradise JL, et al. New vaccines against otitis media: projected benefits and cost-effectiveness. Pediatrics. 2009 Jun. 123(6):1452-63. [Medline].
Shaikh SB, Ahmed Z, Arsalan SA, Shafiq S. Prevalence and resistance pattern of Moraxella catarrhalis in community-acquired lower respiratory tract infections. Infect Drug Resist. 2015. 8:263-7. [Medline].