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Key Features

  • Cause sinusitis, otitis, bronchitis, epiglottitis, pneumonitis, cellulitis, arthritis, meningitis, and endocarditis

  • Risk factors

    • Alcoholism

    • Smoking

    • Chronic lung disease

    • Advanced age

    • HIV infection

Clinical Findings

  • 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

    • Often a severe sore throat despite an unimpressive examination of the pharynx

    • Stridor and respiratory distress result from laryngeal obstruction

  • Meningitis with sinusitis or otitis

Diagnosis

  • Culture

    • Haemophilus species frequently colonize the upper respiratory tract

    • In the absence of positive pleural fluid or blood cultures, distinguishing pneumonia from colonization or from bacterial bronchitis is difficult

  • Epiglottitis: The diagnosis is best made by direct visualization of the cherry-red, swollen epiglottis at laryngoscopy

Treatment

  • 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/day, pending organism susceptibilities

  • H influenzae meningitis

    • Initiate therapy with ceftriaxone, 4 g/day in two divided doses, until the strain is proved not to produce β-lactamase (Table 30–5). Meningitis is treated for at least 7 days

    • Dexamethasone, 0.15 mg/kg intravenously every 6 hours may reduce the incidence of long-term sequelae, principally hearing loss

Table 30–5.Examples of initial antimicrobial therapy for acutely ill, hospitalized adults pending identification of causative organism (in alphabetical order).

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