rifampin and Haemophilus-Infections

Haemophilus influenzae remains a common cause of illness in children throughout the world. Before the introduction of vaccination, H influenzae type b (Hib) disease was the leading cause of bacterial meningitis in young children and a frequent cause of pneumonia, epiglottitis, and septic arthritis. Clinicians should remain diligent in counseling parents on the dangers of Hib and provide vaccination starting at 2 months of age. The epidemiology of invasive H influenzae disease is shifting. It is imperative that clinicians recognize the changing epidemiology and antibiotic resistance patterns for H influenzae to optimize care in hospital and ambulatory settings.

Topics: Anti-Bacterial Agents; Bacteremia; Cephalosporins; Child; Child, Preschool; Female; Haemophilus Infections; Haemophilus influenzae type b; Humans; Incidence; Infant; Male; Meningitis, Bacterial; Pneumonia; Post-Exposure Prophylaxis; Rifampin; Vaccination

The use of rifampicin prophylaxis is recommended in close contacts of individuals with invasive Haemophilus influenzae type b infection if they include a child less than 4 years old in whom the risk of secondary infection is relatively high. In practice, delays in administration of rifampicin, contra-indications to its use and the difficulty of identifying all contacts at risk can reduce significantly its efficacy. Only 1-2% of cases of H. influenzae type b diseases are attributable to known contact and, at best, rifampicin prophylaxis can have little impact on the incidence. In the USA, one in 200 children less than 5 years old is affected. The incidence is probably similar in Australia but there are local differences which could affect the value of preventative measures. The vaccine recently licensed in the USA is not effective in children less than 18-24 months of age in whom the incidence of invasive H. influenzae type b infection, other than epiglottitis, is highest. Nevertheless, it could prevent more than 30% of cases if given to children at the age of 24 months. Vaccines effective in younger infants should become available soon. The best chance of prevention is by the optimal use of both rifampicin prophylaxis and immunization.

Topics: Australia; Bacterial Vaccines; Child, Preschool; Costs and Cost Analysis; Haemophilus Infections; Haemophilus influenzae; Humans; Pharynx; Rifampin; Risk Factors

Topics: Carrier State; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Rifampin

Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.

Topics: Administration, Oral; Administration, Topical; Brazil; Carrier State; Child; Child, Preschool; Chloramphenicol; Conjunctivitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Oropharynx; Purpura; Rifampin; Species Specificity

Rifampin is recommended as a prophylactic treatment for intimate contacts of young children who develop invasive infections with Haemophilus influenzae type B (Hib). A 4-day course of rifampin (20 mg/kg of body weight per day, not to exceed 600 mg as a maximum single daily dose) is 95% effective in eradicating pharyngeal colonization with Hib, thus effectively reducing the risk of both associated patients and recurrent illness in index patients less than 2 years old. This study compares rates of eradication of pharyngeal colonization with Hib for 2- and 4-day courses of rifampin therapy. One hundred sixty-three patients with Hib infection were treated at Children's Hospital of Pittsburgh between January 1986 and December 1988; prophylaxis was recommended for 128. Participating families were randomized to receive either 2- or 4-day therapy. Throat swabs were obtained from contacts prior to therapy. Repeat cultures were obtained from colonized contacts 2 days after completing rifampin and again on all contacts 7 to 10 days after completing therapy. Of 68 participating families, 34 received 2-day and 34 received 4-day therapy with rifampin. Twenty-two of 24 colonized contacts in the 2-day group and 17 of 18 in the 4-day group had negative cultures for Hib on follow-up. Two-day therapy with rifampin appears to be as effective as 4-day treatment in the eradication of Hib pharyngeal colonization.

Topics: Administration, Oral; Adolescent; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Pharynx; Random Allocation; Rifampin

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

We conducted a multicenter trial designed to assess the efficacy of three different drug regimens on eradication of Haemophilus influenzae type b (HIB) from the nasopharynx of household contacts of patients with invasive type b Haemophilus disease. The drug regimens studied were rifampin, 20 mg/kg, once daily for four days; rifampin, 10 mg/kg, twice a day for four days; and placebo, once daily for four days. Shortly after admission of the index patient to the hospital, 26% of 492 household contacts were found to be colonized with HIB. Both rifampin regimens eradicated carriage significantly better than placebo at 10 and 30 days (P = .001). However, among contacts whose cultures were initially negative, new acquisition of the organism occurred infrequently in this 30-day follow-up period regardless of the drug or placebo regimen prescribed. We also measured the concentration of anticapsular antibody in sera obtained from contacts younger than 6 years of age. Samples were obtained soon after admission of the index patient to the hospital and 30 days later. Several carriers younger than 2 years of age had low concentrations of antibody in both specimens. In contrast, nearly all carriers 2 to 5 years of age had high concentrations of antibody even in the first sample. Children who were not carriers usually had low antibody concentrations which did not increase during the period of observation. Our results suggest that most intrafamilial spread of HIB occurs prior to hospitalization of the index patient and stimulates immunity in contacts older than 2 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Carrier State; Child; Child, Preschool; Clinical Trials as Topic; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Pharynx; Random Allocation; Rifampin; Time Factors

To determine the efficacy of rifampin prophylaxis in eradication of oropharyngeal carriage of Hemophilus influenzae type b and prevention of secondary H influenzae type b disease, we conducted a multicenter placebo-controlled trial among selected persons with invasive H influenzae type b disease. Households and day-care classrooms were randomized so that their members received either rifampin (initially at a dose of 10 mg/kg/dose for two to four days [rifampin-10], but subsequently at 20 mg/kg/dose for four days [rifampin-20]) or placebo. Pretherapy H influenzae type b colonization rates were similar in the treatment groups. Therapy with either rifampin regimen significantly reduced carriage (rifampin-20, 97%; rifampin-10, 63%; placebo, 28%). New acquisition of carriage was also significantly reduced by either rifampin regimen (rifampin-20 or rifampin-10, 2% v placebo, 6%). No rifampin-resistant H influenzae type b isolates emerged after treatment. Four of 765 placebo-treated contacts experienced secondary disease in contrast to zero of 1,112 rifampin-treated contacts. Because chemoprophylaxis of close contacts with rifampin seems to reduce significantly the risk of secondary H influenzae type b disease, we recommend the administration of prophylaxis in households or day-care classrooms where children younger than 4 years have been exposed to the disease.

Topics: Adolescent; Age Factors; Carrier State; Child; Child Day Care Centers; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Rifampin

Topics: Administration, Oral; Adult; Child Day Care Centers; Child, Preschool; Clinical Trials as Topic; Disease Outbreaks; Haemophilus Infections; Humans; Medicine; Pediatrics; Random Allocation; Rifampin; Risk; Specialization; United States

We compared the effectiveness of rifampin-trimethoprim in fixed combination (3.75:1) to rifampin alone in the eradication of Haemophilus influenzae type b carriage among contacts of patients with invasive infection caused by this organism. The study population was composed of 127 index patients and 620 contacts. Twenty-six percent of contacts were colonized. Rifampin-trimethoprim eradicated carriage in 77.6% of contacts (71.1% in contacts less than 5 years, 84.2% in contacts greater than or equal to 5 years) whereas rifampin eradicated carriage in 69.9% of contacts (56.4% in contacts less than 5 years, 81.8% in contacts greater than or equal to 5 years). A single isolate resistant to rifampin and rifampin-trimethoprim was encountered. The eradication rate achieved with this regimen of rifampin-trimethoprim was too low to recommend its routine use. However, a higher dose or longer course might merit clinical trial.

Topics: Carrier State; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Patient Compliance; Rifampin; Trimethoprim

H. influenzae can cause not only meningitis in children but epiglottitis, cellulitis, pneumonia, pericarditis, and bacteremia. It is possible to radically reduce, if not abolish, the spread of this pathogen. But effective prophylaxis requires answers to questions of practicability relative to the availability, cost, and logistics of administering rifampin to contacts, as has been recommended.

Topics: Adolescent; Adult; Carrier State; Cellulitis; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Epiglottis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Pericarditis; Pneumonia; Pregnancy; Rifampin; Sepsis; Trimethoprim

Topics: Adolescent; Adult; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Rifampin; United States

To determine the efficacy of rifampin chemoprophylaxis in eradication of oropharyngeal carriage of Haemophilus influenzae type b, we conducted a multicenter, double-blind, placebo-controlled trial among household contacts of patients hospitalized for invasive HIB infection. Seventy-nine index patients and 400 close contacts were studied; 26.5% of contacts were colonized. The efficacy of rifampin (10 mg/kg/dose, 600 mg/dose maximum, twice daily for two days) in eradicating carriage was 52% and varied with age (75.6% in persons greater than or equal to 5 and 27% in those less than 5 years). Eradication rates in those less than 5 years were not significantly better than for placebo. No resistant isolates were encountered in sensitivity testing. The low efficacy of this rifampin regimen in young children precludes its routine use as a chemoprophylactic agent for family contacts. The occurrence of three cases of invasive HIB infection in individuals outside the defined contact group raises concern regarding the efficacy of any chemoprophylactic regimen.

Topics: Clinical Trials as Topic; Double-Blind Method; Epiglottis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Laryngitis; Meningitis, Haemophilus; Microbial Sensitivity Tests; Oropharynx; Placebos; Pregnancy; Rifampin

A prospective, randomized, crossover trial was conducted comparing therapy with rifampin to therapy with ampicillin in eradicating Haemophilus influenzae type b carriage. Twenty-eight carriers were identified in a day care center following exposure to a patient with H influenzae type b meningitis; 26 children were randomly assigned to treatment with either ampicillin (100 mg/kg for five days) or rifampin (20 mg/kg for four days). Cultures were repeated two and four days after discontinuing therapy. In the initial trial, 6/17 children (35%) remained culture positive after treatment with ampicillin compared to 0/9 children treated with rifampin (P = .106). The six children who were ampicillin treatment failures had H influenzae type b isolates sensitive to that drug. These children were subsequently treated with rifampin and their cultures became negative. (For both trials, P = .027). Repeat cultures 30 days after therapy in 20 treated children revealed one culture positive for H influenzae type b. No further cases developed in the day care center (four months of follow-up). These data suggest that rifampin may be more effective than ampicillin in chemoprophylaxis of contacts of H influenzae type b disease.

Topics: Ampicillin; Carrier State; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Prospective Studies; Rifampin

Four episodes of serious Hemophilus influenzae type b infection occurred in three children attending a day-care center. This was 100 times the expected annual total. The pharyngeal carriage rate of Hib was 60% for siblings of patients, 20% for adult household contacts, and 5% for well children at the center. No carriers were found in control populations. Escherichia coli K100, which cross-reacts serologically with Hib, was found in rectal swabs of 20% of family contacts of patients and 3.5% of well children at the center. It was recovered from two of seven persons who carried Hib in the pharynx and two of 75 who did not (P = 0.035), suggesting that carriage of one organism may facilitate carriage of the other. In a randomized prospective trial with 85 patient contact, Hib carriage was eradicated in all of four carriers given ampicillin and in all of three given rifampin. There were no statistically significant differences in the rate of adverse reactions in the two treatment groups. No further cases were reported.

Topics: Ampicillin; Carrier State; Child; Child Day Care Centers; Child, Preschool; Disease Outbreaks; Escherichia coli; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pharynx; Prospective Studies; Rectum; Rifampin

Topics: Adenoviridae; Administration, Oral; Animals; Bacteria; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Conjunctivitis; DNA-Directed RNA Polymerases; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Eye Diseases; Haemophilus Infections; Humans; Isoniazid; Mycobacterium; Mycobacterium tuberculosis; Rifampin; Tuberculosis; Vaccinia; Vaccinia virus

Antibiotics are important for the treatment and prevention of invasive Haemophilus influenzae disease. Reduced susceptibility to clinically relevant drugs, except ampicillin, has been uncommon in the United States. Susceptibility of 700 invasive H. influenzae isolates, collected through population-based surveillance during 2016, was assessed for 15 antibiotics using broth microdilution, according to the CLSI guidelines; a subset of 104 isolates were also assessed for rifampin susceptibility using Etest. Genomes were sequenced to identify genes and mutations known to be associated with reduced susceptibility to clinically relevant drugs. A total of 508 (72.6%) had reduced susceptibility to at least one antibiotic and more than half of the isolates exhibited reduced susceptibility to only one (33.6%) or two (21.6%) antibiotic classes. All tested isolates were susceptible to rifampin, a chemoprophylaxis agent, and <1% (

Topics: Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Rifampin; United States

Haemophilus influenzae serotype a (Hia) can cause severe invasive disease, especially in young children. In 2018, 4 invasive Hia cases occurred in an Alaska community. We used whole-genome sequencing (WGS) to evaluate the relationship of the bacteria from this community and other Alaska patients with invasive Hia.. All carriage (n = 15) and invasive (n = 4) Hia isolates from the outbreak community, together with 15 nonoutbreak Alaska invasive Hia surveillance isolates from 2018, were tested for antimicrobial susceptibility and characterized using WGS.. Phylogenetic analysis of both invasive and carriage Hia isolates revealed 2 major clades that differed by an average of 300 core single-nucleotide polymorphisms (SNPs). All isolates from the outbreak community were clustered in 1 subclade, within a larger clade containing 3 nonoutbreak invasive Hia isolates. Comparative genomics did not reveal any genetic mutations that distinguished carriage from invasive isolates. Three (20%) community isolates were rifampin resistant and had a previously unreported mutation in the rpoB gene.. In the outbreak community, Hia isolates from carriers were indistinguishable from the invasive Hia isolates. Overall, invasive Hia isolates from Alaska in 2018 were genetically similar. The rifampin resistance mutation is concerning as rifampin is the first-line medication for Hia prophylaxis.

Topics: Alaska; Child; Child, Preschool; Disease Outbreaks; Genomics; Haemophilus Infections; Haemophilus influenzae; Humans; Phylogeny; Rifampin; Serogroup

Between May and July 2018, 4 Haemophilus influenzae serotype a (Hia) infections occurred in a remote Alaska community. We performed a public health response to prevent further illness and understand Hia carriage.. We collected oropharyngeal samples community-wide to evaluate baseline carriage. Risk factors were evaluated by interview. We offered prophylactic rifampin to individuals in contact with invasive Hia patients (contacts) and to all children aged <10 years. Oropharyngeal samples were collected again 8 weeks after rifampin distribution. Samples were tested using real-time polymerase chain reaction and culture.. At baseline, 4 of 27 (14.8%) contacts and 7 of 364 (1.9%) noncontacts (P < .01) carried Hia. Contacts aged <10 years were more likely to carry Hia at any timepoint (11/18 [61%]) compared to contacts aged ≥10 years (3/34 [8.8%]), noncontacts aged <10 years (2/139 [1.4%]), and noncontacts ≥10 years (6/276 [2.2%]) (P < .001 for all). Hia carriers were clustered in 9 households (7% of total households). At the household level, carriage was associated with households with ≥1 contact (prevalence ratio [PR], 5.6 [95% confidence interval {CI}, 1.3-21.6]), crowding (PR, 7.7 [95% CI, 1.1-199.5]), and ≥3 tobacco users (PR, 5.0 [95% CI, 1.2-19.6]). Elevated carriage prevalence persisted in contacts compared to noncontacts 8 weeks after rifampin distribution (6/25 [24%] contacts, 2/114 [1.8%] noncontacts; P < .001).. Hia carriage prevalence was significantly higher among contacts than noncontacts. Rifampin prophylaxis did not result in a reduction of Hia carriage prevalence in this community.

Topics: Alaska; Child; Haemophilus Infections; Haemophilus influenzae; Humans; Rifampin; Serogroup

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Child; Child, Preschool; Haemophilus Infections; Haemophilus influenzae type b; Haemophilus Vaccines; Humans; Immunization Schedule; Infant; Infant, Newborn; Middle Aged; Public Health; Rifampin; United Kingdom

Topics: Antibiotics, Antitubercular; Drug Therapy, Combination; Female; Fever; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Male; Pregnancy; Rifampin

Topics: Actinobacillus Infections; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Male; Middle Aged; Pleural Effusion; Rifampin; Time Factors; Treatment Outcome

To investigate most common pathogens isolated from the hospital-acquired pneumonia patients bronchoalveolar lavage fluid in Kaunas University of Medicine Hospital according to the previous antibiotic use and to estimate pathogens antibacterial susceptibility.. Results of 87 hospital-acquired pneumonia patients bronchoalveolar lavage fluid quantitative cultures were analyzed. Microorganisms isolated in clinically significant amount were considered as the etiological agents and included into analysis. Susceptibility was tested using the standard methods. Previously untreated patients were considered if the antibacterials were not administered at all or were used less than for 24 hours.. H. influenzae isolation in significant amount rates were higher in previously untreated patients group comparing to previously treated (29.2%. (n=14) and 5.1% (n=2), respectively, p<0.05). Non-fermenters (P. aeruginosa and Acinetobacter spp.) isolation rates were higher in those previously treated comparing to untreated patients - (31.0% (n=13) and 4.2% (n=2), respectively, p<0.05). All H. influenzae strains were susceptible to ampicillin and cefuroxime. 22.2-44.4% of P. aeruginosa strains were resistant to ceftazidime, amikacin and ciprofloxacin. Estimated Acinetobacter spp. resistance to ciprofloxacin and gentamycin was 83.3% and to ampicillin/sulbactam - 16.7%. All methicillin-susceptible S.aureus were also susceptible to gentamycin and fucidin and methicillin resistant to rifampicin and vancomycin.. Previous antibiotic treatment has an impact on pneumonia etiology testing. H. influenzae strains are more common isolated hospital-acquired pneumonia etiologic agents in previously untreated patients. The low antibacterial resistance was found enabling the use of aminopenicillins for treatment if H. influenzae infection suggested. The use of antibacterials increases non-fermenters isolation rates and combined antipseudomonal treatment is reasonable in these patients.

Topics: Acinetobacter; Acinetobacter Infections; Amikacin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Bronchoalveolar Lavage Fluid; Ceftazidime; Cefuroxime; Ciprofloxacin; Cross Infection; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fusidic Acid; Gentamicins; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Methicillin; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pneumonia, Bacterial; Pneumonia, Staphylococcal; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Staphylococcus aureus; Sulbactam; Vancomycin Resistance

To determine the molecular basis of rifampicin resistance in Haemophilus influenzae.. Mutations in the rifampicin-resistance determining region of the rpoB gene of H. influenzae were analysed by gene amplification and sequencing in 12 rifampicin resistant, one intermediate and four susceptible isolates.. All clinical resistant isolates except one had at least one amino acid substitution in the beta-subunit of RNA polymerase. Eleven resistant isolates had amino acid changes at codons 513, 516, 518, 526 and 533 of cluster I, with the most common amino acid substitution being Asp-516-->Val. Only one resistant isolate also had a second mutation Asn-518-->Asp in cluster I; transformants obtained with DNA of this isolate also had both mutations. All the amino acid changes in cluster I were detected in isolates with a high level of rifampicin resistance (MIC > or =32 mg/L), except the Asp-516-->Ala mutation in a low-level resistant isolate (MIC 4 mg/L). Only one serotype f isolate with an MIC of 2 mg/L had a mutation in cluster II. Cluster III presented no amino acid changes. In in vitro-generated high-level rifampicin-resistant mutants, only amino acid changes at codons 516 and 526 were seen, with new amino acid changes appearing at codon 526 of cluster I, while His-526-->Asn was associated with low-level resistance.. Rifampicin resistance in H. influenzae is due to point mutations in the rpoB gene, and the resistance levels are dependent on both the location and the nature of amino acid substitution.

Topics: Amino Acid Sequence; Amino Acid Substitution; Antibiotics, Antitubercular; Codon; DNA Fragmentation; DNA-Directed RNA Polymerases; DNA, Bacterial; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Haemophilus Infections; Haemophilus influenzae; Humans; Molecular Sequence Data; Mutation; Reverse Transcriptase Polymerase Chain Reaction; Rifampin; Transformation, Bacterial

Topics: Adult; Anti-Bacterial Agents; Chemoprevention; Child; Child, Preschool; Disease Transmission, Infectious; Family Characteristics; Family Health; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infection Control; Male; Rifampin

Topics: Bacterial Capsules; Female; Haemophilus Infections; Haemophilus influenzae type b; Haemophilus Vaccines; Humans; Infant; Polysaccharides, Bacterial; Public Health Practice; Recurrence; Rifampin

Topics: Ceftriaxone; Cerebrospinal Fluid Shunts; Drug Therapy, Combination; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Rifampin

Topics: Bacterial Capsules; Child, Preschool; Drug Administration Schedule; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Infant; Polysaccharides, Bacterial; Rifampin

Topics: Contraindications; Female; Haemophilus Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Meningococcal Infections; Pregnancy; Pregnancy Complications, Infectious; Rifampin; Tuberculosis, Pulmonary

Topics: Age Factors; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Meningococcal; Recurrence; Rifampin

Topics: Bacterial Outer Membrane Proteins; Bacterial Proteins; Bacterial Vaccines; Child; Child, Preschool; Diphtheria Toxoid; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Immunization Schedule; Infant; Polysaccharides, Bacterial; Rifampin; Tetanus Toxoid; Vaccination; Vaccines, Synthetic

To increase awareness of adverse events associated with the use of implantable insulin pumps.. A descriptive case report of a pump implant infection.. This is a case report of one implanted insulin pump-pocket infection among a series of 15 patients. After exposure to a child with a respiratory infection on PID 30, V.L.C. (the patient) developed a fulminant pump-pocket infection. H. influenza was recovered from it. Despite aggressive antibiotic therapy, the infection could not be controlled. Insulin delivery ceased, and the pump was explanted. The pump-pocket infection rapidly resolved with pump removal, permitting later reimplantation.. We have adopted the American Heart Association indications and antimicrobial prophylaxis regimens recommended for prevention of endocarditis in patients with prosthetic values for patients with implanted insulin pumps.

Topics: Adult; Ampicillin; Diabetes Mellitus, Type 1; Drug Therapy, Combination; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Insulin Infusion Systems; Rifampin; Sulbactam

Topics: Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Rifampin

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

Topics: Age Factors; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Rifampin; Risk Factors

Topics: Adult; Bacterial Vaccines; Child; Child, Preschool; Haemophilus Infections; Humans; Immunization Schedule; Infant; Influenza, Human; Rifampin; Vaccination

Topics: Haemophilus Infections; Haemophilus influenzae; Humans; Rifampin

To determine rates of colonisation with Haemophilus influenzae type b among household contacts of children with invasive H influenzae type b disease; compliance among medical staff with recommendations for use of rifampicin prophylaxis; and effects of rifampicin treatment in H influenzae type b colonisation of patients and contacts.. Prospective study of patients and their household contacts.. Royal Children's Hospital (the major paediatric hospital) in Victoria, Australia, with catchment population of 4.2 million, including 300,000 children aged under 5 years.. 234 patients (age range 6 weeks to 8 years) with 235 episodes of all types of invasive H influenzae type b disease admitted during 1988-9 and their contacts.. Positive cultures of H influenzae type b from throat swabs taken at admission and six weeks subsequently; recording of rifampicin prophylaxis.. The percentage of patients with positive throat cultures fell from 69% (33/48) on day 1 of admission to 9% (4/47) after three days' treatment; at six weeks' follow up 32% (32/99) of patients who had not received rifampicin and 8% (5/61) who had, had positive throat cultures. Among household contacts, 33% (62/190) of children and 7% (25/359) of adults were colonised, and the colonisation rates were similar in contacts of patients with all types of H influenzae type b disease. Rifampicin prophylaxis was indicated in 85 families; in 34% it was not prescribed at all for contacts and in 41% not as recommended. The colonisation rates at follow up were significantly less in siblings given rifampicin (12%, 9/78), particularly in families in which all members were treated (3%), than in those in which they were not (36%) (odds ratio 21.5; 95% confidence interval 3.0 to 103.4).. The rate of throat colonisation with H influenzae type b was similar among siblings of children with all types of invasive H influenzae type b disease. Colonisation in contacts can be reduced by rifampicin prophylaxis, but some contacts remained colonised or were recolonised by the time of follow up. Medical staff complied poorly with current recommendations for rifampicin prophylaxis, which reduces its intrinsically limited value in preventing H influenzae type b disease.

Topics: Child; Child, Preschool; Family Health; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pharynx; Prospective Studies; Rifampin

A cost-benefit analysis of Haemophilus influenzae type b disease preventive strategies was updated to consider evaluation of the H. influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) and H. influenzae type b oligosaccharide-mutant diphtheria toxin conjugate vaccine (HbOC) for children at 18 months of age. The analysis was done from the perspective of society as a whole. The economic costs of H. influenzae type b disease in the 1988 United States birth cohort would be $2.546 billion (1988 U.S. dollars) in the absence of preventive efforts. If 60% of all children could be vaccinated with PRP-D or HbOC at 18 months of age, this strategy would save $207.1 million ($88.22 savings/vaccinee; $43,605 cost/case prevented; 3.57/1 benefit-to-cost ratio) under base case model assumptions. Universal PRP-D or HbOC vaccination at 18 months of age would prevent 1845 cases of invasive H. influenzae type b disease. The break-even efficacy for universal PRP-D or HbOC vaccination at 18 months of age was 22.7%. We conclude that, under the model base case assumptions, universal PRP-D or HbOC vaccination at 18 months of age is sufficiently efficacious so that the costs of vaccination would be more than offset by decreased medical care costs for treating H. influenzae type b disease.

Topics: Bacterial Vaccines; Cost-Benefit Analysis; Diphtheria Toxoid; Female; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Infant; Male; Models, Statistical; Rifampin; Time Factors; United States

Topics: Age Factors; Antibodies, Bacterial; Bacterial Capsules; Bacterial Vaccines; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Immunization; Infant; Polysaccharides, Bacterial; Rifampin; Vaccination

Three cases of Haemophilus influenzae type b (Hib) meningitis in a Swedish day care center prompted the investigation of the nasopharyngeal carriage in attendees of that day care center (I), and among children in another day center (II) in the same city, but without meningitis cases. Because the evaluation of the spread of Haemophilus influenzae (Hi) isolates through a population, such as children in day care centers, requires stable identification markers for the bacteria, this study used multilocus enzyme electrophoresis to separate Hib carried by day care attendees from the disease-associated Hib clone. The three meningitis episodes were caused by the same clone of Hib (ET14). This and other Hib clones occurred in the healthy carriers. The frequency of H. influenzae carriage and composition of the H. influenzae flora differed between the two day care centers. Center I with the meningitis cases had a lower overall frequency of H. influenzae carriage, 11 of 40 (28%) compared with both the control day care center (57%) and previous studies. The main difference between the two day care centers was in the nontypable H. influenzae (HiNT) flora. The frequency of HiNT was higher in the center without Hib disease, and there was a higher degree of sharing of HiNT isolates among the children in Center II. This raised the question of an inverse relationship between carriage of HiNT and Hib infection. The results emphasized the importance of accurate identification of the disease isolate in order to estimate the risk of acquisition and dissemination to secondary cases.

Topics: Carrier State; Child Day Care Centers; Child, Preschool; Disease Outbreaks; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Nasopharynx; Rifampin; Sweden

An outbreak of Haemophilus influenzae type b bacteraemia in the infant unit of a paediatric intermediate care hospital is described. A high attack rate of 36% (four of 11 patients) was found, which was of concern in a population already compromised by chronic illness. The use of rifampicin for all patients in the unit, and staff coming into contact with them, as well as general infection control measures, brought the outbreak to an abrupt halt. The place of rifampicin prophylaxis for hospital contacts of patients with systemic H. influenzae is discussed.

Topics: Cross Infection; Disease Outbreaks; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Intermediate Care Facilities; Male; Nursing Homes; Pennsylvania; Rifampin; Sepsis

Topics: Child; Child Day Care Centers; Haemophilus Infections; Haemophilus influenzae; Humans; Rifampin

Haemophilus influenzae type b commonly causes illness in young children, among whom transmission is known to occur. Most adults are believed to be immune to H influenzae type b and outbreaks of disease among adults appear to be uncommon. From July 14 to Aug 12, 1985, a cluster of six cases of acute febrile illness with cultures positive for H influenzae, biotype II (five cases) or untyped H influenzae (one case), occurred among adults in a nursing home and an adjoining hospital. All six case-patients had personal contact with at least one other case-patient. Among the 46 nursing home residents, men were more likely than women to become ill (44% vs 0%). This cluster of disease suggests that elderly adults may be more susceptible to H influenzae infection than is generally recognized and that outbreaks among adults may result from person-to-person transmission.

Topics: Aged; Aged, 80 and over; Antibodies, Bacterial; Cross Infection; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; New York; Nursing Homes; Rifampin; Risk Factors; Sex Factors; Smoking; Space-Time Clustering

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

There is controversy about whether to provide rifampin prophylaxis routinely to contacts in day-care facilities of a patient with a primary case of Hemophilus influenzae type b disease. We prospectively investigated primary cases of H. influenzae type b disease in day-care facilities in Dallas County, Texas, to determine the rate of subsequent disease among contacts. Ninety-one children with primary cases of H. influenzae type b disease who were attending day-care facilities were enrolled from October 1982 to October 1984. A total of 587 classroom contacts of these children under four years of age were not given rifampin. During 60 days of follow-up, there was one subsequent case in a classroom contact. Untreated children under two years of age who were directly exposed to a patient with a primary case were considered to be at highest risk of disease, but there were no subsequent cases in this group of 361 children. However, there were two cases in new enrollees who started attending day-care facilities during the 60-day follow-up period but who were not exposed to a patient with a primary case. At day-care centers in which there was a second case during the follow-up period, there was a high prevalence of colonization with H. influenzae type b in both patient and nonpatient groups of preschool children. These data indicate that the rate of subsequent disease in classroom contacts of patients in day-care facilities is lower than that reported in households (1 of 587 vs. 20 of 829, P = 0.001) and that this rate may be similar to the base rate of primary disease in day-care facilities. We conclude that rifampin prophylaxis may not be appropriate after the occurrence of a primary case of H. influenzae type b disease in a day-care facility in Dallas County.

Topics: Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Prospective Studies; Rifampin; Risk; Texas

Topics: Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Rifampin; Risk

We prospectively studied the risk of secondary transmission of invasive Haemophilus influenzae type b (Hib) disease among children in day care in Oklahoma. We established a statewide surveillance system for the reporting of all forms of invasive Hib disease from physicians, clinical laboratories, county health departments, and infection control practitioners from all hospitals in and bordering Oklahoma. For the 2-year period March 15, 1984, to March 15, 1986, there were 409 culture-confirmed cases of invasive Hib disease in children 12 years of age or younger; 147 (37%) case-patients attended day care. When a case-patient attended day care during the week before illness, we prospectively identified and observed all classroom contacts (n = 2147) for the next 60 days. Of 1253 classroom contacts younger than 4 years of age, seven (0.6%) secondary cases were identified. Isolates from all paired index and secondary cases had identical outer membrane protein (OMP) patterns. Strains causing primary disease were indistinguishable by OMP distribution from those causing secondary disease. Of 685 classroom contacts younger than 2 years of age from whom rifampin use was ascertained, five (1.7%) of 292 who did not receive rifampin became secondary cases, compared with one (0.3%) of 393 who received rifampin (rate ratio 6.7; 95% confidence limits 1.1, 42.5; P less than 0.05). Of 495 classroom contacts 24 to 47 months of age for whom rifampin use was ascertained, one (0.5%) of 194 who did not receive rifampin became a secondary case, compared with none of 301 who received rifampin. This experience indicates that secondary transmission of invasive Hib disease can be appreciable in day care settings, particularly in children younger than 2 years of age, and that rifampin prophylaxis reduces this risk.

Topics: Child; Child Day Care Centers; Child, Preschool; Drug Evaluation; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Oklahoma; Prospective Studies; Rifampin; Risk

Topics: Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Rifampin; United States

Patients treated for Haemophilus influenzae type b disease frequently remain nasopharyngeal carriers of that organism and fail to develop protective concentrations of serum antibody. It has been suggested that rifampin prophylaxis of the index patient may prevent recurrence of disease by eliminating type b Haemophilus carriage. We report nine children who developed second episodes of disease 1 week or more after receiving rifampin prophylaxis. The median interval between the last dose of rifampin and admission to the hospital for the second episode was 70 days (range, 9 to 138). Analysis of biotypes and outer membrane protein polyacrylamide gel electrophoresis patterns of paired isolates from eight cases revealed that the second episodes in two of the children were caused by acquisition of new type b Haemophilus strains, whereas the second episodes in the remaining six children were caused by isolates which were indistinguishable from the respective isolates from the first episodes. Rifampin prophylaxis of the index patient may prevent some episodes of recurrent disease. However, in some patients who have received prophylaxis, second episodes can occur, probably as a result of reacquisition of the organism from contacts who did not receive rifampin or from acquisition of new type b strains.

Topics: Bacterial Outer Membrane Proteins; Carrier State; Electrophoresis, Polyacrylamide Gel; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Recurrence; Rifampin

Topics: Ampicillin; Aortic Rupture; Aortic Valve; Echocardiography; Endocarditis, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Medical Illustration; Middle Aged; Necrosis; Rifampin; Suppuration

Topics: Disease Outbreaks; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Rifampin

We studied the efficacy of rifampin prophylaxis in reducing the prevalence of ampicillin- and chloramphenicol-resistant Haemophilus influenzae type b in four day care facilities after each center had individual cases of invasive infections (two meningitis, one pneumonia and one cellulitis) caused by multiply resistant organisms. Rifampin was given in a single daily dose of 20 mg/kg for 4 days. Cultures were taken pretreatment and 10 days after the last dose of rifampin. Included in the study were 174 children and 27 adults. We identified a total of 55 nasopharyngeal carriers; 45 received rifampin and 10 refused treatment. On the 10-day follow-up culture in the second sample, 95.5 and 20%, respectively, of treated and untreated children were no longer colonized with H. influenzae (P less than 0.001, Fisher's exact test). We conclude that rifampin can successfully reduce the prevalence of multiply resistant H. influenzae type b carriers attending day care centers.

Topics: Adult; Ampicillin Resistance; Carrier State; Child Day Care Centers; Child, Preschool; Chloramphenicol Resistance; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Nasopharynx; Rifampin

Topics: Child; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Recurrence; Rifampin

Three cases of ecchymotic cellulitis in 7 to 11 month old infants are reported. Haemophilus influenzae was isolated from blood in two cases. Ecchymotic cellulitis in infants should, in the first place, evoke an Haemophilus influenzae infection. Bacteremia being frequent in this condition, blood cultures should be performed.

Topics: Amoxicillin; Ampicillin; Cellulitis; Ecchymosis; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Rifampin

Topics: Ampicillin; Anti-Bacterial Agents; Carrier State; Child, Preschool; Female; Haemophilus Infections; Humans; Pregnancy; Pregnancy Complications, Infectious; Rifampin

Topics: Bacterial Capsules; Bacterial Vaccines; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Immunization; Infant; Polysaccharides, Bacterial; Rifampin; Risk; United States

In 1982, an outbreak of Haemophilus influenzae type b disease occurred in a 379-member Amish community. In an attempt to control the outbreak after the occurrence of the second case of disease, we investigated the combination of (1) rifampin chemoprophylaxis of all carriers of H influenzae type b and their household contacts from 1 month to 5 years of age and (2) H influenzae type b polysaccharide vaccine immunoprophylaxis of all community members 12 months of age and older. Despite our intervention, two additional cases of bacteremic H influenzae type b disease occurred in the ensuing 5 months, one in a 22-month-old infant who had been immunized at 19 months of age and the other in a child who had not been immunized because she was younger than 12 months of age. The outbreak ended following rifampin prophylaxis of all community members younger than 15 years of age. All of the children with disease were genetically related to one another, and three of the four were inbred. However, analysis of their coancestry revealed that neither the average level of kinship nor the average inbreeding level of the affected children differed significantly from those of the other children in the community. Furthermore, none of the four children with disease shared a human leukocyte antigen haplotype. Our observations suggest that inbreeding was not a risk factor in this community.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacterial Vaccines; Carrier State; Cellulitis; Child; Child, Preschool; Disease Outbreaks; Disease Susceptibility; Ethnicity; Follow-Up Studies; Haemophilus Infections; Haemophilus influenzae; Humans; Immunization; Immunization, Secondary; Infant; Infant, Newborn; Meningitis, Haemophilus; Missouri; Pedigree; Polysaccharides, Bacterial; Rifampin; Rural Population

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

Topics: Bacterial Capsules; Bacterial Vaccines; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Immunization; Infant; Polysaccharides, Bacterial; Rifampin; Risk; United States

A cluster of toxic reactions among children inadvertently given excessive doses of rifampin for chemoprophylaxis of invasive Haemophilus influenzae disease in a day-care center was investigated. In all 19 children, who received five times the therapeutic dose of rifampin, dramatic adverse reactions developed. A striking, "glowing" red discoloration of the skin and facial or periorbital edema were found to be the hallmarks of rifampin toxicity. These clinical signs of acute toxicity contrast sharply with the adverse side effects of rifampin reported with therapeutic doses.

Topics: Acute Disease; Child Day Care Centers; Child, Preschool; Edema; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Medication Errors; Pigmentation Disorders; Rifampin; Scalp Dermatoses; Skin Diseases; Vomiting

Strategies for management of children attending day-care facilities after a case of Haemophilus influenzae type b disease are controversial. The success of chemoprophylaxis in preventing subsequent cases has been variable. Failure of rifampin prophylaxis as currently recommended may result from usage limited to direct contacts of the index patient. This prospective study was designed to ascertain the extent of colonization in household contacts of colonized children attending day-care facilities with an index case of H influenzae disease. Outer membrane protein analysis was used to determine similarity between strains isolated from contacts and index patients. Of children attending six day-care facilities, 15% were colonized with subtypes of H influenzae identical with those of their respective index patients, and 7% of children were colonized with different subtypes. Colonization with identical outer membrane protein subtypes in children from day-care homes was more frequent than in the larger day-care centers (91% v 8%, P less than .00001). Within families of children with identical outer membrane protein subtypes, 25% of household members (17% of parents and 44% of siblings) were colonized despite lack of direct contact with the index patients. This colonization rate was comparable to that of household contacts of index patients (26%). Among household contacts of index patients, especially siblings, colonization with H influenzae tended to be lower if the patient attended day care than if the patient did not attend day care (17% v 73%; P = .05 for siblings). We have found that household contacts of colonized day-care children are a reservoir of H influenzae.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacterial Outer Membrane Proteins; Child Day Care Centers; Child, Preschool; Disease Reservoirs; Family; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Prospective Studies; Rifampin; Serotyping

The emergence of ampicillin and chloramphenicol resistant Haemophilus influenzae type b in Denmark has created demands for alternative treatments of serious infections with H. influenzae. In this study 102 strains of H. influenzae recovered from cerebrospinal fluid (85) and blood (17) were tested for susceptibility to ampicillin, piperacillin, erythromycin, rifampicin, chloramphenicol, cefuroxime, cefotaxime, ceftazidime, ceftriaxone, moxalactam, aztreonam, and netilmicin by means of the agar dilution method. The majority (97%) was H. influenzae type b and of these strains 94% belonged to biotype I. Nine of the investigated strains were beta-lactamase producers. Ceftriaxone and cefotaxime were the most active agents (MIC90 less than or equal to 0.025 microliter/ml) followed by moxalactam and aztreonam (MIC90 = 0.1 microgram/ml). Except for ampicillin and piperacillin, the MIC was similar for beta-lactamase producers and non-producers. Several of the investigated antibiotics, especially some of the third generation cephalosporins, might constitute valid therapeutical alternatives to conventional drugs in the treatment of severe H. influenzae infections.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Chloramphenicol; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Netilmicin; Rifampin; Sepsis

Topics: Bacterial Vaccines; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; 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

The risk factors for acquisition of secondary day-care-associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle-King County, Washington; Atlanta; and the state of Oklahoma. During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities. In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom. Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old. Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease. Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease. Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%). For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts.

Topics: Age Factors; Bacterial Outer Membrane Proteins; Child Day Care Centers; Child, Preschool; Georgia; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Meningitis, Haemophilus; Oklahoma; Rifampin; Risk; Time Factors; Washington

Topics: Ampicillin; Carrier State; Cerebrospinal Fluid; Child, Preschool; Chloramphenicol; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Nasopharynx; Pharynx; Prospective Studies; Rifampin

Day-care centers are a relatively new phenomena of American society that bring together large numbers of young children susceptible to contagious disease. This study examines the incidence and risk factors of endemic Hemophilus influenzae type b disease both in the general population and in day-care attendees in Monroe County, New York, for 1982 and 1983. The attack rate in the general population (excluding day-care attendees) was highest in children younger than 1 year (131.9 cases per 100,000 per year) and in those 1 to 2 years old (75.7 cases per 100,000 per year) compared with older children. The relative risk for day-care attendees was much greater than that of the general population. It was 12.3 times greater for children younger than 1 year, 7.2 times greater for those 1 to 2 years old, and 3.8 times greater for those 2 to 3 years old. We conclude that children attending day-care facilities face a substantial increased risk of contracting invasive H influenzae type b disease. Efforts to prevent susceptibility and contagious spread of this disease in this population seem necessary.

Topics: Age Factors; Child; Child Day Care Centers; Child, Preschool; Epidemiologic Methods; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; New York; Nurseries, Infant; Rifampin; Risk; Socioeconomic Factors

Topics: Child Day Care Centers; Child, Preschool; Disease Susceptibility; Family; Haemophilus Infections; Haemophilus influenzae; Humans; Rifampin

Topics: Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Rifampin

Topics: Chlamydia Infections; Drug Resistance, Microbial; Drug Therapy, Combination; Haemophilus Infections; Humans; Meningitis, Meningococcal; Rifampin; Staphylococcal Infections; Trimethoprim

This study in 32 patients was undertaken to determine the penetration of rifampicin into bone tissue using the recently developed intravenous formulation of this antibiotic. 300 mg rifampicin given as an intravenous injection over 5 min followed by 300 mg slow intravenous drip infusion over 1 h give a plasma level of rifampicin of more than 2 micrograms/ml for 6 h. In patients with osteomyelitis, bone rifampicin concentrations ranged from 1.4 to 8.8 micrograms/g at 2.5-3.5 h after the start of treatment. Osteomyelitis due to gram-positive organisms and to Haemophilus can be treated with rifampicin in combination with a second antibiotic, depending on the minimum inhibitory concentration of the infecting organism(s).

Topics: Adult; Aged; Bone and Bones; Haemophilus Infections; Humans; Infusions, Parenteral; Kinetics; Middle Aged; Osteomyelitis; Rifampin

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

Topics: Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Rifampin

Recent promulgation of an official policy on prevention of secondary cases of Haemophilus influenzae type b disease illustrates the challenges and frustrations inherent in the policy-making process. Despite evidence that H influenzae type b disease is "contagious" in households and probably also in day care centers and despite demonstration that rifampin eradicates nasopharyngeal H influenzae type b carriage, the single field study of rifampin use to prevent secondary cases of H influenzae type b disease remains unpublished and has yet to receive broad critical scrutiny. Promulgation of the rifampin strategy prior to publication of this critical study is unfortunate, as public and private providers are now committed to a policy that will be difficult to evaluate or alter. Now that the strategy has been issued, the central question regarding rifampin prophylaxis has changed from "Is this strategy effective?" to "Can this strategy be shown to be ineffective?" When policies are issued prior to publication of key supporting data, or when such studies are either missing or highly controversial, the policy-making committee might publish, along with its recommendations, explicit criteria for continuation, modification, or withdrawal of the new policy. This structured reassessment approach could accommodate the critical need to proceed with disease control recommendations--even though based on incomplete information--yet underscore the policy's tentative nature and provide direction for future assessment and study.

Topics: Academies and Institutes; Centers for Disease Control and Prevention, U.S.; Child Day Care Centers; Child, Preschool; Disease Outbreaks; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Policy Making; Rifampin; Risk; United States

The increasing incidence of Haemophilus influenzae resistant to ampicillin has clinical implications not only for pediatricians but also for family physicians, because the bacterium is recognized more frequently as the etiologic agent for diseases in adults as well as in young children. Ampicillin is no longer the automatic choice for treatment of patients thought to have life-threatening H influenzae disease, and empiric treatment of otitis media must be reexamined. Chloramphenicol, as well as ampicillin, must be considered for the treatment of meningitis and other serious systemic H influenzae infections. Once the infective organism has been isolated and tested for resistance, ampicillin alone may be used if indicated or desired. Alternatives to ampicillin for middle ear infection are trimethoprim-sulfamethoxazole (Bactrim, Septra), erythromycin-sulfonamide (Pediazole), and cefaclor (Ceclor). Isolation and susceptibility tests are seldom done because they necessitate tympanocentesis.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Otitis Media; Penicillin Resistance; Pneumonia; Respiratory Tract Infections; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Meningitis due to Haemophilus influenzae serotype b biotype II occurred in a 2-year-old child who attended a nursery school along with 26 other 2-year-old children. Nasal swabs from these 26 contacts revealed a H influenzae type b colonization rate of 50% (13/26); simultaneously performed throat swabs detected a colonization rate of 4% (1/26). Biotyping of the H influenzae type b isolates revealed that only 46% (6/13) were the same biotype as the index case; the remaining seven isolates were biotype III. All children received treatment with 20 mg/kg/day of rifampin administered by the nursery school attendant as a single dose for four days before the results of the cultures were known. Eradication of H influenzae type b carriage was successful in three of the six biotype II carriers and five of the six biotype III carriers available for follow-up culture. It was concluded that: (1) the culture site utilized in determining H influenzae type b colonization rates may markedly influence the results obtained; (2) biotyping may be a valuable epidemiologic tool in investigating the contacts of patients with H influenzae type b disease, and (3) failures of rifampin to eradicate the carriage of H influenzae type b from the nasopharynx may occur. The prudent approach to the management of young contacts of patients with serious H influenzae type b disease is to recognize their high risk status and to maintain close surveillance of them. The role of chemoprophylaxis with rifampin remains to be established.

Topics: Bacteriophage Typing; Child, Preschool; Epidemiologic Methods; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Nasopharynx; Nurseries, Infant; Rifampin

Topics: Carrier State; Drug Synergism; Haemophilus Infections; Haemophilus influenzae; Humans; Kinetics; Microbial Sensitivity Tests; Rifampin; Trimethoprim

Although all of 14 clinical isolates of Haemophilus influenzae type b strains demonstrated rifampin susceptibility in vitro (minimal inhibitory concentration less than or equal to 0.4 microgram/ml) when an inoculum of 10(4) colony-forming units (CFU) was used, 10 of the 14 strains manifested resistance to this agent when an inoculum of 10(8) CFU was tested. The mutation rate for rifampin resistance ranged from 1 resistant colony per 3.5 x 10(6) CFU to 1 per 4 x 10(7) CFU. The emergence of rifampin-resistant mutants was prevented when trimethoprim was combined with rifampin. This finding suggests that when used alone for prophylaxis of H. influenzae type b nasopharyngeal carriers, rifampin is likely to lead to the emergence of resistant strains.

Topics: Colony-Forming Units Assay; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Rifampin; Trimethoprim

Epiglottis (more properly supraglottitis) is a potentially life-threatening infection of the supraglottic larynx that is most often caused by Hemophilus influenzae type B (HITB). Intrafamily spread of HITB disease has been described often for meningitis, but is rarely reported in epiglottis. We describe two siblings seen concurrently with HITB epiglottitis and discuss prophylaxis of family members and close contacts.

Topics: Child, Preschool; Epiglottis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Laryngitis; Male; Rifampin

Topics: Adult; Cefaclor; Cephalexin; Drug Evaluation; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Microbiological Techniques; Middle Aged; Rifampin; Saliva; Suspensions; Tablets; Time Factors

The efficacy of cefaclor and rifampin in eradicating Haemophilus influenzae type b (HITB) from the nasopharynx of day care center and household contacts of children with HITB meningitis was evaluated. In 38/50 children treated with cefaclor, the carrier state persisted, a failure rate of 76%. Although cefaclor failed to eradicate HITB from many carriers, an appreciable reduction in the intensity of colonization following treatment was noticed. When rifampin was used in 17 children who had failed to respond to cefaclor, persistence of the carrier state with HITB was found in only two children, a failure rate of only 12%. During the study, two episodes of invasive HITB disease were documented to be acquired from sources other than the index cases or from children who were screened, which suggested the need to reevaluate the usually recommended strategy to screen for carriage and to treat only the immediate contacts 6 years of age and younger. Furthermore, the most appropriate agent for eradicating nasopharyngeal carriage of HITB awaits additional studies.

Topics: Adult; Carrier State; Cefaclor; Cephalexin; Child; Child Day Care Centers; Child, Preschool; Evaluation Studies as Topic; Family; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Nasopharynx; Rifampin

Topics: Adolescent; Child; Child, Preschool; Haemophilus Infections; Humans; Rifampin

Topics: Carrier State; Cefaclor; Child; Drug Therapy, Combination; Erythromycin; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pharyngitis; Rifampin; Sulfisoxazole

Household contacts less than 6 years of age of children with Haemophilus influenzae type b meningitis are at increased risk of developing systemic H influenzae type b disease. Positive oropharyngeal cultures for H influenzae type b were found in 17/97 patients (18%) and 7/62 staff members (11%) at a chronic area facility at which two patients had developed ampicillin-resistant H influenzae type b meningitis. H influenzae type b colonization was eliminated in 8/9 carriers treated with a single daily oral dose of rifampin, 20 mg/kg/day (maximum 600 mg) for four days; colonization persisted in 9/10 control subjects (Fisher's exact test P < .001; corrected chi 2 P < .005). After treatment of additional H influenzae type b-positive individuals and the remaining control subjects, rifampin was found to have eradicated H influenzae type b in a total of 24/25 carriers (96%). All isolates of H influenzae type b were sensitive to rifampin at either 0.5 or 1.0 microgram/ml. Rifampin is effective in eliminating the H influenzae type b carrier state and may be useful in preventing associated H influenzae type b disease in close contacts of children with H influenzae type be meningitis.

Topics: Carrier State; Child; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Pharynx; Rifampin

The dynamics of nasopharyngeal colonization, bacteremia, and transmission of infection due to Haemophilus influenzae type b in infant rats were studied. Intranasal inoculation resulted in nasal colonization in 99% and bacteremia in 88% of infant rats. H. influenzae type b was transmitted to 93% of exposed, uninoculated littermates. Pretreatment with burro antibody to H. influenzae type b prevented bacteremia but not nasal colonization. Rifampin, in a dose of 20 mg/kg twice daily for two days, was 97% and 100% effective in eradicating two strains of H. influenzae type b from the nasopharynx. Efficacies of 10 mg/kg twice daily and 5 mg/kg twice daily for two days were 86% and 6%, respectively. No rifampin-resistant isolates were encountered in animals still colonized after rifampin therapy. This model for haemophilus colonization and intralitter transmission could be used to evaluate other chemoprophylactic agents and may provide additional insight into the epidemiology and immunology of haemophilus infections.

Topics: Animals; Animals, Newborn; Antibodies, Bacterial; Disease Models, Animal; Female; Haemophilus Infections; Haemophilus influenzae; Nasopharyngeal Diseases; Nasopharynx; Pregnancy; Rats; Rifampin; Sepsis

Topics: California; Carrier State; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Microbial Sensitivity Tests; Nasopharynx; Rifampin