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Ciprofloxacin-resistant Haemophilus influenzae infection in a patient with chronic lung disease

S L Barriere1, J A Hindler

  • 1Department of Pharmaceutical Services, University of California, Los Angeles 90024.

The Annals of Pharmacotherapy
|March 1, 1993
PubMed
Abstract

Insights

This case report details a patient with chronic lung disease who developed ciprofloxacin-resistant Haemophilus influenzae infections after repeated antibiotic use. Judicious fluoroquinolone use is crucial to maintain efficacy against common pathogens.

Area of Science:

  • Infectious Diseases
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Chronic lung disease and combined immunodeficiency predispose patients to recurrent pulmonary infections.
  • Haemophilus influenzae is a common pathogen in patients with chronic lung disease.
  • Fluoroquinolones are frequently used for treatment and prophylaxis of respiratory infections.

Observation:

  • A patient with severe combined immunodeficiency and bronchiectasis experienced recurrent pulmonary infections.
  • The patient had received multiple courses of ciprofloxacin for treatment and prophylaxis.
  • Isolates of Haemophilus influenzae previously susceptible to ciprofloxacin became resistant after repeated exposure.

Findings:

  • Haemophilus influenzae isolates demonstrated resistance to ciprofloxacin and ofloxacin (MICs 8 and 16 mg/L, respectively).
  • Previous isolates were highly susceptible to ciprofloxacin (MIC < or = 0.06 mg/L).
  • The patient responded to ceftizoxime and was discharged on cefixime.

Implications:

  • This case suggests fluoroquinolone resistance can develop in Haemophilus influenzae, a pathogen previously considered susceptible.
  • Repetitive exposure to ciprofloxacin may induce resistance in the patient's flora.
  • Judicious use of fluoroquinolones is essential to preserve their activity against important pathogens in community-acquired infections.

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