Haemophilus influenzae infection treatment

So far only four cases of an interaction between rifampicin and chloramphenicol appear to have been reported. However, the evidence is of good quality and in line with the way rifampicin interacts with other drugs, so this interaction should be taken seriously. There is a risk that serum chloramphenicol levels will become subtherapeutic. The authors of the second report point out that raising the chloramphenicol dosage may possibly expose the patient to a greater risk of bone marrow aplasia. They suggest delaying rifampicin prophylaxis in patients with invasive Haemophilus influenzae infections until the end of chloramphenicol treatment. 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

Unlabeled Uses Prophylaxis of Haemophilus influenzae type b infection treatment of atypical mycobacterial infection and serious infections caused by Staphybcoccus spe-... 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Disease that is segmental or lobar in its distribution is usually caused by Streptococcus pneumoniae (pneumococcus). Haemophilus influenzae is a rare cause in this group, although it more often leads to exacerbations of chronic bronchitis and does cause pneumonia in patients infected with HIV. Benzyl-penicillin i.v. or amoxicillin p.o. are the treatments of choice if pneumococcal pneumonia is very likely alternatively, use erythromycin/clarithromycin in a penicillin-allergic patient. Seriously ill patients are best given benzylpenicillin (to cover the pneumococcus) plus ciprofloxacin (to cover Haemophilus and atypical pathogens). Where penicillin-resistant pneumococci are prevalent, i.v. cefotaxime is a reasonable best guess choice. 

It is believed that the lung infection results from impaired mucus clearance followed by colonization of bacteria in the mucus. The bacteria elaborate a number of toxins, polysaccharides, and enzymes including proteases, elastases, and exotoxin A, which may stimulate the production of additional mucus and further contribute to airway obstruction (Sam et al., 1980 Adler et al., 1983). Pseudomonas aeruginosa and Staphylococcus aureus are the most commonly found bacteria in the lungs of patients with CF, but Klebsiella, Esherichia coli, streptococci, and Haemophilus influenza can also be found. Of particular interest is the observation that mucoid strains of infectious bacteria, which are more pathogenic than nonmucoid strains, are most commonly found in patients with CF (Reynolds et al., 1975, 1976). The mucoid strains are also more resistant to phagocytosis by alveolar macrophages and are impermeable to antibiotics because of their mucoid coats. Thus treatment of pulmonary infections in patients with CF can be unusually difRcult. 

Azithromycin, an azalide macrolide antibiotic (500 mg p.o. as a single dose on day 1, followed by 250 mg daily on days 2 to 5 total accumulation dose is 1.5 g), is indicated in the treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease caused by Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, or Streptococcus pneumoniae mild community-acquired pneumonia caused by H. influenzae or S. pneumoniae uncomplicated skin and skin-structure infections caused by Staphylococcus aureus, Streptococcus pyogenes, or S. agalactiae second-line therapy of pharyngitis or tonsillitis caused by S. pyogenes and in nongonococcal urethritis or cervicitis caused by Chlamydia trachomatis. 

One also often may successfully combine two bacteriostatic antibiotics for special purposes, such as a macrolide and a sulfonamide. Occasionally, these are used in combination for the treatment of an upper respiratory tract infection caused by Haemophilus influenzae, because the combination of a protein biosynthesis inhibitor and an... 

Ampicillin is essentially equivalent to benzylpenicillin for pneumococcal, streptococcal, and meningococcal infections, and many strains of Gram-negative Salmonella, Shigella, Proteus mirabllls, and Escherichia coll, as well as many strains of Haemophilus influenzae and Neisseria gonorrhoeae, respond well to oral treatment with ampicillin. 

Children are most susceptible to ear infections from antibiotic-resistant strains of Haemophilus influenzae, Staphylococcus aureus. Streptococcus pneumoniae, and Branhamella catarrhalis. The above treatment plan has been found highly effective for treating such infections. 

Chloramphenicol (Fig. 8.24) is an antibacterial agent that is used topically to treat infections of the eye and ear, but systemic treatment is reserved for treatment of life-threatening diseases such as those caused by Haemophilus influenzae and typhoid fever. Systemic administration through oral or parenteral delivery poses several problems chloramphenicol has a very bitter taste that cannot be masked effectively by conventional flavouring agents, which means there are therefore formulation problems that are needed to overcome poor patient acceptance. Additionally, poor water solubility makes formulation as an aqueous solution for parenteral administration difficult. Formation of the palmitate ester renders the compound virtually tasteless, and, whilst it remains relatively insoluble in water, it can be formulated as an oral suspension to enable good patient acceptance. Enzymatic... 

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