Haemophilus influenzae type b meningitis
In adults and children with meningitis caused by Haemophilus influenzae type b (Hib), drug choice depends on whether susceptibility to benzylpenicillin has been confirmed and whether the patient is hypersensitive to penicillins. When Hib infection has been confirmed:
- start directed therapy (see regimens below)
- continue dexamethasone therapy for a total of 4 days (empiric + directed)
- consider whether clearance antibiotics for close contacts are required
- report the case of Haemophilus influenzae type b infection to the local public health authority because it is a notifiable condition12
- give age-appropriate catch-up Hib vaccination, after recovery, in patients younger than 5 years who have not been fully vaccinated – see the Australian Immunisation Handbook.
For the treatment of meningitis caused by Hib in adults and children, use:
1ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, 12-hourly for 7 days 3 ceftriaxone ceftriaxone ceftriaxone
OR
1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly for 7 days. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment cefotaxime cefotaxime cefotaxime
PLUS
dexamethasone 10 mg (child: 0.15 mg/kg up to 10 mg) intravenously, preferably starting before the first dose of antibiotic, then 6-hourly for a total of 4 days (empiric + directed therapy). dexamethasone dexamethasone dexamethasone
If susceptibility to benzylpenicillin is confirmed, de-escalate therapy and use:
benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) intravenously, 4-hourly for 7 days. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment benzylpenicillin benzylpenicillin benzylpenicillin
PLUS
dexamethasone 10 mg (child: 0.15 mg/kg up to 10 mg) intravenously, preferably starting before the first dose of antibiotic, then 6-hourly for a total of 4 days (empiric + directed therapy). dexamethasone dexamethasone dexamethasone
Clearance antibiotics for Hib infection are required if the patient was treated with benzylpenicillin alone, because it does not reliably clear nasopharyngeal carriage.
For adults and children who have had a nonsevere (immediate or delayed) or severe immediate4 hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime (see dosages above).
For adults and children who have had a severe delayed5 hypersensitivity reaction to a penicillin, use:
ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 8-hourly for 7 days6. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment ciprofloxacin ciprofloxacin ciprofloxacin
PLUS
dexamethasone 10 mg (child: 0.15 mg/kg up to 10 mg) intravenously, preferably starting before the first dose of antibiotic, then 6-hourly for a total of 4 days (empiric + directed therapy). dexamethasone dexamethasone dexamethasone