rifampin and Epiglottitis

We carried out a nonrandomized, unblinded study to compare the efficacy of rifampin alone with that of rifampin in combination with trimethoprim in the eradication of the Haemophilus influenzae type b (HIB) carrier state among contacts of patients with invasive HIB infection. The study population comprised 17 index patients admitted to hospital with severe HIB infections and 233 contacts, 43 of whom had nasopharyngeal colonization with HIB of the same biotype as that of the index patient. Rifampin in a daily dose of 20 mg/kg (maximum 600 mg) for 4 days eradicated the carrier state in 86% of cases, as did the combination of rifampin at the same dosage and trimethoprim in a daily dose of 5 mg/kg (maximum 160 mg) for 4 days.

Topics: Adult; Child; Child, Preschool; Clinical Trials as Topic; Drug Synergism; Drug Therapy, Combination; Epiglottitis; Follow-Up Studies; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Microbial Sensitivity Tests; Rifampin; Trimethoprim

In the new countries of the Federal Republic Germany the incidence of systemic Hib-infections is lower than in the old FRG. In children under the age of 5 years the incidence of Hib-meningitis is 8/100,000 and of all systemic Hib-diseases about 17/100,000. By Hib-vaccination (PRP-D) severe diseases can be prevented. The recommended chemoprophylaxis with Rifampicin is important in this connection, too.

Topics: Bacterial Vaccines; Child, Preschool; Epiglottitis; Germany; Germany, East; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Rifampin

With an increased awareness of appropriate management of childhood epiglottitis, overall morbidity and mortality has decreased. However, some trends have developed over the past several years that are variations on the classic picture. In a series of 42 patients seen from 1977 to 1986, epiglottitis has occurred in a progressively younger population. Thirty-six percent of our patients were found to be less than 2 years old, and 51% were less than 3 years old. Also, the causative organism, Haemophilus influenzae, has been found to be increasingly ampicillin-resistant. The incidence, presentation, management, and outcome of the patients are reviewed, and compared to similar data from other series in the literature.

Topics: Ampicillin; Child, Preschool; Chloramphenicol; Epiglottitis; Female; Haemophilus influenzae; Humans; Indiana; Intubation, Intratracheal; Laryngoscopy; Male; Prevalence; Rifampin; Seasons; Time Factors; Tracheotomy

A cost-benefit analysis for Haemophilus influenzae type b disease prevention was developed to examine two officially recommended preventive strategies: H influenzae type b capsular polysaccharide immunization and rifampin prophylaxis of exposed contacts. The social costs of H influenzae type b disease in the 1984 US birth cohort will be $1.937 billion when base case assumptions are made. If it is assumed that 60% of all children could be vaccinated at 24 months of age, universal vaccination has the highest economic benefits of any single preventive strategy considered (net savings $64.8 million). Rifampin prophylaxis of appropriate household contacts has the highest benefit to cost ratio (59:1), but because rifampin prevents only secondary disease, only half as many cases can be prevented with rifampin prophylaxis of appropriate household contacts (501 cases prevented, $1,994 per case prevented) as with universal vaccination at 24 months (985 cases prevented, $63,484 per case prevented). Single-dose vaccination of day-care attendees at 18 months of age is the most expensive preventive strategy considered ($148,445 per case prevented, 306 cases prevented). Rifampin prophylaxis of appropriate day-care contacts prevents the fewest H influenzae type b cases ($46,041 per case prevented, 72 cases prevented.

Topics: Adolescent; Adult; Age Factors; Bacterial Capsules; Bacterial Vaccines; Child; Child, Preschool; Cost-Benefit Analysis; Epiglottitis; Evaluation Studies as Topic; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Immunization Schedule; Infant; Infant, Newborn; Meningitis, Haemophilus; Middle Aged; Models, Theoretical; Polysaccharides, Bacterial; Rifampin; Vaccination

Based on evidence that patients with infections due to Haemophilus influenzae type b (HIB) remain colonized after therapy, recommendations for chemoprophylaxis of susceptible contacts have included providing rifampin for patients themselves. However, these recommendations have been made with neither definitive advice concerning the timing of rifampin administration nor any supporting data of efficacy and safety in patients. Our data suggest that rifampin given concurrently with therapeutic antimicrobials is as effective-89% (17/19)--as when given following therapeutic antimicrobials-95% (18/19)--in eradicating pharyngeal HIB. Colonization of the pharynx by HIB was also determined before and during therapy. Almost all patients were colonized before beginning therapy; most were heavily colonized. The density of colonization diminished rapidly during the first 15 to 20 hours of therapy. However, 28% of patients, primarily those who had HIB diseases other than meningitis or did not receive any chloramphenicol, still had detectable colonization after four to six days of antimicrobial therapy.

Topics: Cellulitis; Child, Preschool; Epiglottitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Pharyngitis; Rifampin

Epiglottitis (supraglottitis) in the adult, once thought a rare entity, has been reported in the literature with increasing frequency since the late 1960s. Five cases occurring in our hospital over a 12-week period prompted this report. Historical and literature reviews followed by five case reports and discussion, illustrate the important diagnostic and therapeutic features of this disease.

Topics: Adult; Airway Obstruction; Epiglottitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Laryngitis; Male; Middle Aged; Rifampin; Staphylococcal Infections

Tolerance to beta-lactam antibiotics has been described with staphylococci and enterococci, but this phenomenon and its clinical significance in Haemophilus influenzae has not been reported. We have reported a case of bacteremic epiglottitis due to an ampicillin-tolerant, beta-lactamase-negative strain of Haemophilus influenzae type b which was cured with ampicillin therapy alone. The organism was not tolerant to moxalactam, cefotaxime, or rifampin. Rifampin therapy eliminated pharyngeal carriage.

Topics: Ampicillin; Cerebrospinal Fluid; Drug Therapy, Combination; Epiglottitis; Haemophilus Infections; Haemophilus influenzae; Humans; Laryngitis; Male; Middle Aged; Penicillin Resistance; Pharynx; Rifampin