• Cause sinusitis, otitis, bronchitis, epiglottitis, pneumonitis, cellulitis, arthritis, meningitis, and endocarditis
• Risk factors
– Chronic lung disease
– Advanced age
– HIV infection
• Typical bacterial pneumonia, with purulent sputum containing a predominance of gram-negative, pleomorphic rods
Epiglottitis is characterized by an abrupt onset of fever, drooling, and inability to handle secretions
Meningitis with sinusitis or otitis
• For patients with sinusitis, otitis, or respiratory tract infection
– Amoxicillin, 500–875 mg twice daily orally (not effective for β-lactam–producing strains) for 10–14 days
– Amoxicillin/clavulanate, 875 mg/125 mg twice daily orally for 10–14 days
– Levofloxacin, 500 mg once daily for 10–14 days
• For patients with penicillin allergy
– Oral cefuroxime axetil, 250 mg twice daily for 7 days or
– An oral fluoroquinolone (ciprofloxacin, 500 mg twice daily; levofloxacin, 500–750 mg once daily; or moxifloxacin, 400 mg once daily) for 7 days
– When a macrolide is the preferred agent, azithromycin, 500 mg orally once followed by 250 mg daily for 4 days, is preferred over clarithromycin
– Oral trimethoprim-sulfamethoxazole, 160/800 mg twice daily, can be considered but resistance rates have been reported as high as 25%
• In the seriously ill patient use ceftriaxone, 1 g/d, pending organism susceptibilities
• H influenzae meningitis
– Initiate therapy with ceftriaxone, 4 g/d in two divided doses, until the strain is proved not to produce β-lactamase (Table 30–5). Meningitis is treated for 10–14 days
– Dexamethasone, 0.15 mg/kg intravenously every 6 hours may reduce the incidence of long-term sequelae, principally hearing loss
Content adapted from CURRENT Medical Diagnosis & Treatment 2014.
• Absence of skull fracture does not exclude the possibility of severe head injury
• In many elderly patients, there may not be a known history of head trauma
• Occasionally, head injury, often trivial, precedes symptoms by several weeks
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