Oral therapy for Haemophilus influenzae pneumonia

Oral therapy for Haemophilus influenzae pneumonia is recommended whenever possible. Use intravenous therapy for patients with more severe H. influenzae pneumonia (eg patients with complications such as bacteraemia or pericarditis). Use the results of susceptibility testing to guide treatment.

For H. influenzae pneumonia in adults and children who can tolerate and absorb oral (or enteral) therapy, if the isolate is susceptible to amoxicillin, use:

amoxicillin 1 g (child: 25 mg/kg up to 1 g) orally or enterally, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. See Duration of therapy for Haemophilus influenzae pneumonia. amoxicillin amoxicillin amoxicillin

If the isolate is resistant to amoxicillin or ampicillin (ie beta-lactamase producing), or if the results of susceptibility testing are not available, use:

amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally or enterally, 12-hourly¹. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. See Duration of therapy for Haemophilus influenzae pneumonia. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

For adults and children with hypersensitivity to penicillins, if the pathogen is susceptible to doxycycline and the patient does not have high-severity pneumonia², use:

doxycycline orally or enterally, 12-hourly³; see Duration of therapy for Haemophilus influenzae pneumonia doxycycline doxycycline doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg⁴

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg.

For adults and children with hypersensitivity to penicillins, if the pathogen is not susceptible to doxycycline or the patient has high-severity pneumonia², use:

ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally or enterally, 12-hourly. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. See Duration of therapy for Haemophilus influenzae pneumonia. ciprofloxacin ciprofloxacin ciprofloxacin

In children with hypersensitivity to penicillins who do not have high-severity pneumonia and in whom a suitable formulation of doxycycline is not available, trimethoprim+sulfamethoxazole may be a suitable alternative – seek expert advice.

¹ Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months but a different dosage is required.Return

² Assessment of pneumonia severity is included for community-acquired pneumonia (CAP) in adults and children 2 months or older, and hospital-acquired pneumonia (HAP) in adults and children.Return

³ An oral liquid formulation of doxycycline is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

⁴ When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return

⁵ An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

⁶ Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return