Basic Principles of Antiparasitic Chemotherapy

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The microbiology laboratory confirmed H influenzae type b and demonstrated that the isolate was beta-lactamase-positive. Ampicillin is inactivated by penicillinases unless used in combination with an inhibitor of such enzymes. Beta-lactamase-producing isolates of H influenzae type b are not resistant to chloramphenicol or to third-generation cephalosporins. 

Although the cerebrospinal fluid was apparently sterile, the counterimmunoelectrophoresis analysis suggests a relapse caused by H influenzae type b owing to inadequate treatment with chloramphenicol or development of resistance. 

The third-generation cephalosporins cefotaxime and ceftriaxone are effective in the empiric treatment of bacterial meningitis caused by most strains of meningococci, pneumococci, and H influenzae. However, the prevalence of drug-resistant S pneumoniae ctin influence empiric therapy and may necessitate the addition of vancomycin. Note that some isolates of H influenzae are now resistant to both ampicillin and chloramphenicol. 

Rifampin is recommended for household or day care contacts of the index case with meningitis due to H influenzae type b, and the drug would also be prophylactic for close contacts of meningococcal meningitis. 

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Katzung PHARMACOLOGY, 9e > Section VIII. Chemotherapeutic Drugs > Chapter 52. Basic Principles of Antiparasitic Chemotherapy > ... 

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