• 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
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess Profile while you are actively authenticated on this website
via your institution (you will be able to tell by looking in the top right corner
of any page – if you see your institution’s name, you are authenticated). You will
then be able to access your institute’s content/subscription for 90 days from any
location, after which you must repeat this process for continued access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessMedicine Full Site: One-Year Subscription
Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.
Pay Per View: Timed Access to all of AccessMedicine
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.