Multiply-resistant Haemophilus influenzae type b causing systemic disease in children in Australia

Until 1984 strains of Haemophilus influenzae type b (Hib) isolated from children with systemic infections in Australia had been uniformly sensitive to chloramphenicol. In July 1984 a child with bacteremia in Adelaide, South Australia, yielded a strain of Hib resistant to ampicillin, chloramphenicol and tetracycline. In October and November 1984 similar isolates were obtained on cerebrospinal fluid culture from 2 children with meningitis. The 3 isolates showed an identical resistance pattern and inactivated ampicillin and chloramphenicol. Each isolate was fully sensitive to moxalactam (latamoxef), and to cefotaxime. Both children with meningitis were treated initially with ampicillin and chloramphenicol given intravenously. One of these, a girl aged 16 mth, showed no improvement and a sixth cranial nerve palsy developed. When ampicillin and chloramphenicol were ceased and moxalactam was substituted there was a rapid clinical improvement. As initial therapy in children with bacterial meningitis we advocate using either moxalactam and ampicillin in combination or a suitable third generation cephalosporin such as cefotaxime.