Intravenous therapy for Haemophilus influenzae pneumonia

Oral therapy for Haemophilus influenzae is recommended whenever possible. Use intravenous therapy for patients who:

have more severe H. influenzae pneumonia (eg patients with complications such as bacteraemia or pericarditis)
are unable to tolerate or absorb oral (or enteral) therapy.

Use the results of susceptibility testing to guide treatment.

For adults and children with more severe H. influenzae pneumonia (eg patients with complications such as bacteraemia or pericarditis), or patients who are unable to tolerate or absorb oral (or enteral) therapy, if the isolate is susceptible to amoxicillin or ampicillin, use:

1amoxicillin 1 g (child: 25 mg/kg up to 1 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. Switch to oral therapy once the patient improves amoxicillin amoxicillin amoxicillin

1ampicillin 1 g (child: 25 mg/kg up to 1 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see ampicillin dosage adjustment. Switch to oral therapy once the patient improves. ampicillin ampicillin ampicillin

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

1ceftriaxone 1 g (child 1 month or older: 50 mg/kg up to 1 g) intravenously, daily. Switch to oral therapy once the patient improves ceftriaxone ceftriaxone ceftriaxone

1cefotaxime 1 g (child: 50 mg/kg up to 1 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. Switch to oral therapy once the patient improves. cefotaxime cefotaxime cefotaxime

For adults and children who have had a nonsevere (immediate or delayed) or a severe immediate¹ hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime as above.

For adults and children who have had a severe delayed² hypersensitivity reaction to a penicillin, treatment depends on the results of susceptibility testing. If the isolate is susceptible to ciprofloxacin, oral (or enteral) ciprofloxacin is preferred because it has excellent bioavailability. If oral therapy is not possible, or the patient has complications of H. influenzae pneumonia (eg bacteraemia, pericarditis), use:

ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 12-hourly³. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. Switch to oral therapy once the patient improves. ciprofloxacin ciprofloxacin ciprofloxacin

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

³ 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