How is bacteremia 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

Bacteremia precedes essentially all invasive Hib infection.

Approximately 30-50% of children with occult Hib bacteremia (bacteremia without an identifiable cause) develop a focus of infection such as meningitis, cellulitis, or pneumonia. Therefore, reevaluate these children (including with lumbar punctures and chest radiography) for an infectious focus and obtain repeat blood cultures.

Administer parenteral antibiotics for at least 2-5 days and guide subsequent therapy based on the focus of infection. If no focus is identified, substitute oral antibiotics to complete 7-14 days of therapy, as in other gram-negative bloodstream infections/bacteremias.

Studies have been conducted to determine the optimal treatment duration for gram-negative bacteremia. It has been reported that 7 days (or even less) of antibacterial treatment for gram-negative bacteremia results in similar clinical response rates and microbiological cure rates when compared with treatment durations of 8-14 days and more than 14 days. [86]

A retrospective study of uncomplicated gram-negative bacteremia in children showed that antibiotic treatment for more than 10 days did not decrease the risk of treatment failure compared to shorter therapy and may increase the risk of candidemia. [87]

In contrast, a newer study on uncomplicated gram-negative bacteremia concluded that there was an increased risk of treatment failure in patients given antibiotic therapy for just 7-10 days compared with those who were treated for more than 10 days, supporting the traditional 2 weeks of treatment. Additional risk factors identified for treatment failure included liver cirrhosis and immune compromise. Definitive antibacterial treatment with intravenous or highly bioavailable oral agents decreased the risk of treatment failure. [88]

International guidelines for the management of sepsis and septic shock published by Rhodes et al in 2017 still suggest 7-10 days of antibacterial treatment "for most serious infections associated with sepsis and septic shock," which would include bacteremias. However, the authors labelled it as a weak recommendation based on low quality of evidence. [89]

Patients with pericarditis, empyema, endocarditis, endophthalmitis, or osteomyelitis require antibiotic treatment durations specific to the condition (and not the bacterial pathogen).


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