Antibiotics are the mainstay of treatment of H. influenzae infections. H. influenzae is susceptible to sulfonamides, chlor-amphenicol, ciprofloxacin, ampicillin, cefotaxime, and ceftazi-dime. Cefotaxime and ceftriaxone are the initial drugs of choice of treatment of Hib meningitis. These antibiotics given paren-terally to patients with uncomplicated meningitis for 7–14 days are effective. Penicillins are useful in the management of muco-sal infections caused by nonencapsulated H. influenzae. As many as 25–50% of isolates produce beta-lactamase; therefore, they are resistant to this class of drugs. Beta-lactamase-producing oral antibiotics, with activity against H. influenzae, include tri-methoprim–sulfamethoxazole, cefuroxime axetil, cefixime, clarithromycin, azithromycin, and ciprofloxacin. These drugs are given for 10 days in cases of otitis media and for at least 14 days for sinusitis.
The Hib conjugate vaccine, now routinely given to infants and children, is highly effective. The vaccine has dramatically reduced the prevalence of invasive Hib disease. The vaccine elic-its a protective antibody response and prevents Hib disease by reducing pharyngeal colonization with Hib. The Hib conjugate vaccine, however, is not effective against disease caused by non-typable H. influenzae.
Originally, the Hib vaccine was an unconjugated polysac-charide vaccine, which consisted of the purified PRP capsu-lar polysaccharide. This vaccine, however, was not effective because it induced a poor immune response, did not protect children fully, and did not provide any antibody protection for infants. This therefore led to the development of the con-jugate Hib vaccines in which PRP is covalently linked to a protein.
Chemoprophylaxis by rifampin is used to reduce the coloniza-tion of Hib disease in children with high risk. Such high-risk group includes children below 2 years in a family or daycare centre where systemic disease is reported.
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