How is Haemophilus influenzae type b (Hib) meningitis treated?

Updated: Jul 09, 2018
  • Author: Prateek Lohia, MD, MHA; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

The first attempts at treatment, which resulted in only modest reductions in the high mortality rate of Haemophilus influenzae type b (Hib) meningitis, involved the administration of antisera generated by intrathecal inoculation of horses. Not infrequently, this form of immunotherapy had untoward immune consequences, including serum sickness, conjunctival edema, and anaphylaxis. Alexander developed much more effective antisera in rabbits in 1939.

Although sulfonamides proved disappointing at first, combining this antibiotic with Alexander’s antisera in 1942 resulted in the first great therapeutic breakthrough, with a reduction of the mortality rate to 26%, although the combination induced untoward immune-mediated reactions in more than 40% of patients.

The year 1944 saw the introduction of streptomycin. The use of this antibiotic—systemic and intrathecal, often in combination with either Alexander’s antisera or sulfadiazine or both—reduced the mortality rate to 3.4% by 1947. Chloramphenicol replaced streptomycin in 1950 because its excellent penetration of the blood-brain barrier eliminated the need for intrathecal treatment. In combination with sulfadiazine, chloramphenicol remained the treatment of choice until this role was assumed by ampicillin.

The most critical aspect of initial treatment of meningitis is prompt initiation of antimicrobial therapy, because any delay in treatment is associated with increased morbidity and mortality. Anti-inflammatory therapy remains controversial, but dexamethasone may help prevent hearing loss. When necessary, increased intracranial pressure (ICP) can be treated with mannitol.

Go to Meningitis, Meningococcal Meningitis, Staphylococcal Meningitis, Tuberculous Meningitis, Viral Meningitis, and Aseptic Meningitis for complete information on these topics.


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