Pediatric Haemophilus Influenzae Infection Medication

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Aggressive parenteral antibiotic therapy is required for severe forms of Haemophilus influenzae disease, particularly those caused by the type b strain. More mild forms of disease (ie, sinopulmonary infections caused by nontypeable strains of Haemophilus organisms) may be treated with various oral antibiotics. Only therapies for invasive H influenzae infection are reviewed here.

Third-generation cephalosporins have become the cornerstone of therapy for invasive H influenzae infections, including meningitis, because of their potent bacteriocidal activity and penetration into the subarachnoid space.

Semisynthetic penicillins, particularly ampicillin, may be useful in H influenzae meningitis if the isolate is beta-lactamase negative.

Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum gram-negative activity, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Cefotaxime (Claforan)

Arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth. Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms.

Cefepime (Maxipime)

So-called fourth-generation cephalosporin with good gram-negative coverage. Similar to third-generation cephalosporins but has better gram-positive coverage. Excellent penetration into CNS; indicated for treatment of adult and pediatric meningitis.

Meropenem (Merrem)

Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. Effective against most gram-positive and gram-negative bacteria. Has slightly increased activity against gram-negative species and slightly decreased activity against staphylococci and streptococci compared with imipenem. In contrast to imipenem, indicated for treatment of bacterial meningitis, including pediatric meningitis.

Chloramphenicol (Chloromycetin)

Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.

Ampicillin (Marcillin, Omnipen, Polycillin, Principen)

Agent with cell wall activity that interferes with transpeptidation step of peptidoglycan biosynthesis. Has bactericidal activity against susceptible organisms. Resistance of H influenzae to ampicillin occurs in 10-40% of patients. Use in combination with chloramphenicol.

Class Summary

Glucocorticosteroids elicit anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli. Use of adjunctive glucocorticosteroid therapy has been demonstrated to decrease the risk of sensorineural deafness in children with H influenzae meningitis.

Dexamethasone (Decadron)

For various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of PMNs and reducing capillary permeability. For maximum benefit, corticosteroids should be initiated as soon as possible in treatment of H influenzae meningitis, ideally prior to the first dose of antibiotics.

Class Summary

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components, which act as antigens. Administration of the vaccine stimulates production of antibodies with specific protective properties. For a complete overview of current vaccine recommendations, see the Advisory Committee on Immunization Practices (ACIP) guidelines from the Centers for Disease Control and Prevention (CDC).^[6]

Haemophilus influenza type b vaccine (ActHIB)

Used for routine immunization of children against invasive diseases caused by H influenzae type b by decreasing nasopharyngeal colonization. CDC's ACIP recommends that all children receive one of the conjugate vaccines licensed for infant use beginning routinely at age 2 mo.

Class Summary

Chemoprophylaxis is used to prevent secondary disease. With widespread success of immunization, chemoprophylaxis now is of mostly historical interest.

Rifampin (Rimactane, Rifadin)

Inhibits RNA synthesis in bacteria by binding to beta subunit of DNA-dependent RNA polymerase, which in turn blocks RNA transcription.