How are nonencapsulated (NTHi) Haemophilus influenzae infections treated?

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

These organisms can cause mucosal infections treatable with oral antibiotics. The first-line antibiotic for otitis media is high-dose amoxicillin (80-90 mg/kg/day in 2 divided doses) because it is safe, inexpensive, and palatable and covers a narrow microbiologic spectrum. Amoxicillin-clavulanate (amoxicillin 90 mg/kg/day, with clavulanate 6.4 mg/kg/day in 2 divided doses) is recommended in patients who have received amoxicillin in the preceding 30 days, patients with coexisting conjunctivitis, or patients with otitis media due to beta-lactamase–positive H influenzae. [90] Penicillin-allergic individuals may be treated with erythromycin-sulfisoxazole or cefaclor. Cefaclor has weak activity against beta-lactamase–producing bacteria and causes a serum sickness–like illness in 2% of patients. Approximately 25-50% of NTHi strains produce beta-lactamase and, therefore, are resistant to amoxicillin and ampicillin.

Oral antibiotics with activity against beta-lactamase–producing H influenzae include trimethoprim-sulfamethoxazole, cefuroxime axetil, cefixime, clarithromycin, azithromycin, and fluoroquinolones. Patients with conjunctivitis should receive topical antibiotics such as sulfacetamide and erythromycin.

In children younger than 2 years and in children with severe symptoms, the standard 10-day antibiotic course is recommended. In children aged 2-5 years who have mild to moderate acute otitis media, 7 days of oral antibiotic therapy is recommended. In children aged 6 years or older who have mild to moderate symptoms, 5-7 days of antibacterial therapy is considered adequate. [90]

The recommended duration of antimicrobial treatment for uncomplicated acute bacterial rhinosinusitis in adults is 5-7 days, while, in children, the recommended course of therapy is still 10-14 days. [91]

Administer parenteral antibiotics to patients with invasive NTHi infection, which can be treated similarly to invasive Hib disease.

Andrographalide is being evaluated for its potential in preventing lung inflammation due to NTHi infection, especially in cigarette smokers. [34]


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