How is meningitis treated in patients with Haemophilus influenzae infections?

Updated: Jul 02, 2019
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Administer parenteral antibiotics (eg, ceftriaxone, ceftazidime, cefotaxime, ampicillin-sulbactam, fluoroquinolones, azithromycin) to patients with meningitis for 7 days. Third-generation cephalosporins (cefotaxime and ceftriaxone) are the initial drugs of choice for suspected Hib meningitis.

Once the susceptibilities are known, adjust antibiotics accordingly.

For beta-lactamase–positive H influenzae meningitis, the recommended standard antibiotic is a third-generation cephalosporin. Alternative antimicrobials include cefepime, chloramphenicol, and fluoroquinolones. For beta-lactamase–negative H influenzae meningitis, the recommended standard antimicrobial is ampicillin, while any of those mentioned for beta-lactamase–positive H influenzae meningitis may be used as an alternative.{ref1-INVALID REFERENCE}

Do not use ampicillin empirically, since as many as 80% of global isolates are resistant, usually because of plasmid-mediated beta-lactamase production. [60, 61, 62, 63, 64, 65, 66]

Cefuroxime is also not recommended because delayed sterilization is more common.

Chloramphenicol produces adequate bactericidal blood and CSF levels but is now used infrequently because it requires monitoring of drug levels and can result in dose-dependent (though reversible) bone marrow toxicity (particularly in neonates and patients with liver disease) or an idiosyncratic aplastic anemia.

Dexamethasone is an important adjunctive treatment in patients with meningitis who are older than 2 months because it has been shown to decrease the inflammatory response and the rate of hearing loss [67] and other neurological complications. [68]


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