Treatment of Haemophilus influenzae Type b Infections

First-Line Antibiotic Therapy

The American Academy of Pediatrics recommends ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours for 10 days as the first-line treatment for H. influenzae type b meningitis and other invasive infections 1, 2
The Infectious Diseases Society of America recommends treatment duration of 10 days for H. influenzae infections 1, 2
Third-generation cephalosporins are preferred due to their excellent CSF penetration and activity against both β-lactamase-producing and non-producing strains 3

Moxifloxacin 400 mg once daily can be used as an alternative if cephalosporins cannot be administered 2
Chloramphenicol (25 mg/kg every 6 hours) may be considered as an alternative in settings where cephalosporins are not available 1

Local antibiotic resistance patterns should be considered when selecting therapy 4
Cephalosporins maintain excellent activity against most H. influenzae strains, including ampicillin-resistant isolates 3

If there is no clinical improvement after 48-72 hours, consider evaluating for antibiotic resistance 3
If there is no clinical improvement after 48-72 hours, consider adding or switching to an alternative agent 3

The Centers for Disease Control and Prevention recommends rifampin chemoprophylaxis for index patients treated with antibiotics other than cefotaxime or ceftriaxone 5
The Centers for Disease Control and Prevention recommends rifampin chemoprophylaxis for all household contacts in households with members aged <4 years who are not fully vaccinated 5, 6
Rifampin dosage: 20 mg/kg once daily (maximum 600 mg) for 4 days 6

The Centers for Disease Control and Prevention recommends vaccination as the primary preventive measure against H. influenzae type b disease 7, 8
Previously unvaccinated household contacts under age 10 should receive Hib vaccination 6
Antibiotic prophylaxis is recommended for preventing infection with encapsulated organisms (including H. influenzae) among allogeneic stem cell transplant recipients with chronic GVHD 9

Vancomycin should never be used alone for treatment of meningitis due to concerns about CSF penetration 3
Not providing appropriate chemoprophylaxis to close contacts can result in secondary cases 5, 6