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Cause sinusitis, otitis, bronchitis, epiglottitis, pneumonitis, cellulitis, arthritis, meningitis, and endocarditis
Risk factors
Alcohol use disorder
Smoking
Chronic lung disease
Advanced age
HIV infection
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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
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For patients with sinusitis, otitis, or respiratory tract infection
Amoxicillin, 750 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
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
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