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Meningitis due to Haemophilus influenzae type b resistant to ampicillin and chloramphenicol
L B Givner1, J S Abramson, B Wasilauskas
1Department of Pediatrics, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27103.
Abstract:
Invasive disease due to Haemophilus influenzae type b (Hib) resistant to chloramphenicol and ampicillin is rare in the United States. Review of the literature reveals that all previously reported cases occurred in children with meningitis. These children were treated initially with ampicillin and chloramphenicol and had complicated courses characterized by delayed sterilization of the cerebrospinal fluid. The present report describes an infant who developed meningitis due to ampicillin- and chloramphenicol-resistant Hib. The patient received cefotaxime from the onset of therapy and had an uncomplicated course. The presence of Hib strains resistant to chloramphenicol and ampicillin should be considered in patients with meningitis due to Hib who respond poorly to treatment with these two drugs. Furthermore, the in vitro susceptibility of all Hib isolates to chloramphenicol (as well as to other antimicrobial agents) should be evaluated routinely. If the incidence of such resistant organisms increases, a change will be warranted in the commonly recommended combination of ampicillin and chloramphenicol as empiric therapy for bacterial meningitis in pediatric patients.
Insights
Invasive Haemophilus influenzae type b (Hib) infections resistant to chloramphenicol and ampicillin are rare but can cause severe meningitis. Early cefotaxime therapy may lead to uncomplicated recovery in such cases.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Invasive disease caused by Haemophilus influenzae type b (Hib) resistant to chloramphenicol and ampicillin is infrequently reported in the United States.
- Previous literature indicates that all reported cases of resistant Hib invasive disease occurred in children diagnosed with meningitis.
Observation:
- The study details an infant with meningitis caused by Hib strains exhibiting resistance to both ampicillin and chloramphenicol.
- This infant received cefotaxime as the initial therapeutic agent and experienced an uncomplicated clinical course.
Findings:
- The report highlights a case of ampicillin- and chloramphenicol-resistant Hib meningitis in an infant.
- The patient treated with cefotaxime demonstrated an uncomplicated recovery, contrasting with previously reported complicated courses in similar cases.
Implications:
- Clinicians should consider the possibility of chloramphenicol- and ampicillin-resistant Hib in meningitis cases with a poor response to these antibiotics.
- Routine in vitro susceptibility testing of all Hib isolates to chloramphenicol and other antimicrobials is recommended.
- An increase in resistant Hib strains may necessitate revising the standard empiric therapy for bacterial meningitis in pediatric patients, potentially moving away from the ampicillin-chloramphenicol combination.