What is the treatment for Haemophilus (H.) influenzae type b (Hib) infection?

Treatment of Haemophilus influenzae Type B (Hib) Infection

For invasive Haemophilus influenzae type b (Hib) infections, third-generation cephalosporins such as cefotaxime or ceftriaxone are the recommended first-line treatments due to their effectiveness in both treating the infection and eradicating nasopharyngeal colonization. 1, 2

Antibiotic Treatment

First-Line Treatment

• Third-generation cephalosporins:
  • Cefotaxime or ceftriaxone 1, 2, 3, 4
  • These antibiotics not only treat the infection but also eradicate Hib colonization, eliminating the need for additional rifampin prophylaxis 1

Alternative Treatments

• For patients with cephalosporin allergies or contraindications:
  • Ampicillin (if susceptible strains) plus chloramphenicol 4, 5
  • Note: Due to increasing ampicillin resistance, susceptibility testing is crucial before using ampicillin alone 3

Treatment Duration

• For meningitis: 10-14 days
• For other invasive infections: 7-10 days (depending on clinical response)
• Complete the full course of antibiotics even if symptoms improve quickly

Post-Treatment Management

Rifampin Prophylaxis

Rifampin prophylaxis is indicated in specific situations:

1. For index patients:

   • Patients <2 years of age who were treated with antibiotics other than cefotaxime or ceftriaxone should receive rifampin prior to hospital discharge 1
   • No prophylaxis needed if treated with cefotaxime or ceftriaxone 1

2. For household contacts:

   • All household contacts in households with members <4 years who are not fully vaccinated 1
   • All household contacts in households with immunocompromised members <18 years, regardless of vaccination status 1

3. For childcare contacts:

   • When two or more cases of invasive Hib disease have occurred within 60 days and unimmunized or underimmunized children attend the facility 1
   • Should be prescribed for all attendees and childcare providers regardless of age or vaccine status 1

Special Considerations

High-Risk Populations

• Patients with functional or anatomic asplenia, HIV infection, immunoglobulin deficiencies, or complement deficiencies require special attention 1, 6
• Hematopoietic stem cell transplant recipients should receive 3 doses of Hib vaccine beginning 6-12 months after transplant, regardless of prior vaccination history 1

Prevention in Contacts

• Household contacts exposed to persons with Hib disease should receive rifampin prophylaxis if all contacts aged <4 years are not fully vaccinated 1
• Pediatric household contacts should be up-to-date with Hib vaccinations to prevent possible Hib exposure to vulnerable individuals 1

Common Pitfalls to Avoid

1. Failure to identify high-risk patients: Patients with sickle cell disease, asplenia, or immunodeficiencies are at increased risk for invasive Hib disease 6
2. Inadequate prophylaxis: Not providing rifampin prophylaxis to appropriate contacts can lead to secondary cases 1
3. Incomplete treatment: Stopping antibiotics early when symptoms improve can lead to treatment failure
4. Not distinguishing between type b and non-type b H. influenzae: Chemoprophylaxis is not recommended for contacts of persons with invasive disease caused by non-type b H. influenzae 1

By following these treatment guidelines, clinicians can effectively manage Hib infections while preventing secondary cases and reducing morbidity and mortality associated with this once-common but now rare invasive disease.