Hemophilus influenza---also spelled Haemophilus influenza or Haemophilus influenzae---is a Gram-negative, aerobic bacterium implicated in a spectrum of diseases ranging from invasive infections of the central nervous system to superficial infections of the skin, according to the Centers for Disease Control and Prevention (CDC). The introduction of an effective vaccine in 1988 resulted in a 99 percent decrease in the incidence of H. influenza infections in the United States, although the World Health Organization (WHO) notes that the disease continues to pose a major public health threat in developing countries. H. influenza treatment consists of antibiotics and supportive care.
Culture and Sensitivity Testing
Treatment of H. influenza begins with testing. Hospital or clinic laboratories grow---or culture---bacteria obtained from the patient and evaluate their response---or sensitivity--to various antibiotics. Doctors use the results to guide the choice of antibiotics for each individual patient.
Types of Antibiotics
According to Dr. Timothy Murphy in "Harrison's Principles of Internal Medicine," intravenous antibiotics used to treat H. influenza include cefotaxime and ceftriaxone. Oral antibiotics include the amoxicillin and clavulanic acid, several cephalosporins, azithromycin, clarithromycin, telithromycin and, for adults aside from pregnant women, fluoroquinolones.
Administration
The type of infection dictates the route of administration. Invasive infections require admission to the hospital for treatment with intravenous antibiotics. Non-invasive infections such as skin, ear and sinus infections can be managed on an outpatient basis with oral antibiotics. Many patients with invasive infections also transition to oral antibiotics after their symptoms improve.
Drug Resistance
The WHO reports that ampicillin-resistant strains of H. influenza are an increasing problem, especially in Europe, Japan and developing countries. Murphy advises that such strains remain rare in the United States, but the situation requires ongoing monitoring. Patients can do their part toward preventing antibiotic resistance by completing their full, prescribed course of medication.
Supportive Care
Many patients with H. influenza infections require supportive care to prevent or treat some of the symptoms or complications of the infection. For example, patients with central nervous system infections receive corticosteroids to quell inflammation and reduce the risk of seizures and permanent brain damage. Children with breathing problems due to H. influenza are routinely intubated as a precautionary measure because some of them develop inflammation that interferes with breathing and, by the time this complication presents itself, it becomes extremely difficult to perform the procedure. Supportive care treats symptoms, but not the disease itself.
Effectiveness
The CDC says 2 percent to 5 percent of children with invasive H. influenza infections die, despite antibiotics and supportive care. Twenty percent to 30 percent of survivors become permanently disabled with problems such as mental retardation, deafness, neurological disorders, scars and amputations. Vaccination of children and people with certain kinds of medical problems prevents the disease.
References
- CDC: Hemophilus Influenza Type B and HiB Vaccine--Epidemiology and Prevention of Vaccine-Preventable Diseases
- "Harrison's Principles of Internal Medicine (17th edition)"; A.S. Fauci, E. Braunwald, D.L. Kasper, S.L. Hauser, D.L. Longer, J.L. Jameson and J. Loscalzo; 2008
- WHO: Hemophilus Influenza Type B (HiB)
