Haemophilus influenzae (HI) infection is a common disease in children. Clinically, bacteremia , meningitis, pneumonia, otitis media , sinusitis and vulvovaginitis are common. The Infection Group of the Pediatrics Branch of the Chinese Medical Association, the Chinese Children’s Infectious Diseases Etiology and Bacterial Resistance Surveillance (ISPED) Collaborative Group, and the Chinese Journal of Pediatrics Editorial Committee organized domestic experts to jointly develop the "Children’s Haemophilus Influenza Diagnosis and Treatment Expert Recommendations", to provide recommendations for the diagnosis of HI infection, anti-infective treatment strategies, and new ideas for vaccine prevention.
Antibacterial treatment
Sensitive antibacterial drugs can be selected according to the characteristics of local HI in vitro drug sensitivity. For those who are already undergoing antibacterial treatment, the rules in Table 1 can be combined to determine whether to change antibacterial drugs.
1. Pulmonary infection : For mild pneumonia, oral cefdinir or cefixime and other third-generation cephalosporins are recommended. Severe patients should be administered intravenously. The first choice is ceftriaxone, 50～80mg/(kg•times), 1 time/d, or cefotaxime 50 mg/(kg•times), 1 every 8 hours Second, the course of treatment is 5 to 7 days. For those with pulmonary complications such as empyema, the course of treatment can be extended to 2 to 4 weeks or even longer as appropriate.
is sensitive to macrolides HI infection, if the child is allergic to penicillins , cephalosporins, azithromycin can be used as a secondary drug. HI that is sensitive to azithromycin may be resistant to clarithromycin,The in vitro drug susceptibility results of the two are not completely consistent, and attention should be paid when choosing therapeutic drugs.
2. Otitis media : Local treatment includes cleaning the ear canal and draining pus. HI is highly sensitive to levofloxacin, and levofloxacin ear drops can be applied topically.
In severe cases, systemic treatment can be considered as appropriate, such as oral third-generation cephalosporin; in severe cases, third-generation cephalosporin drugs such as ceftriaxone and cefotaxime can be considered as appropriate. The total course of treatment is not Less than 7 d.
Patients with clear HI infection and susceptibility to azithromycin can give priority to oral azithromycin. For those caused by NTHi, because bacteria can easily form biofilms in children's middle ears, the treatment fails. Consider the combined application of azithromycin and other macrolide antibacterial drugs to inhibit the formation of bacterial biofilms and enhance the antibacterial effect.
Azithromycin dose 5-10 mg (kg•times), 1 time/d, total amount 30 mg/kg, 3-5 days is a course of treatment.
3. acute sinusitis : oral antibacterial drugs are preferred third-generation cephalosporins; in severe cases, intravenous infusion of ceftriaxone and cefotaxime may be considered as appropriate. The course of treatment was 7 days after the clinical symptoms were obviously controlled.
4. conjunctivitis : Use levofloxacin eye drops 1-2 drops each time, once every 4-6 hours, and use levofloxacin ointment at night until the condition is cured. If necessary, rinse with sterile normal saline.
5. Vulvovaginitis : 0.5% to 1.0% povidone-iodine solution can be used for local cleansing. Antibacterial drugs include topical application of levofloxacin gel, most of which can be cured. Reproductive tract strains are generally more sensitive to β-lactam antibacterials, and those with severe symptoms can also take orally amoxicillin . Clavulanic acid, cefuroxime or third-generation cephalosporins.
Severe infections, especially those with respiratory tract infections, can use the aforementioned antibacterial drugs intravenously. The general course of treatment is 7-10 days.
6. Sepsis without local lesions: First choice ceftriaxone, 50-80 mg/(kg•times), 1 time/d, or choose cefotaxime 50 mg/(kg•times), once every 8 hours; severe Patients can consider carbapenem antibacterial drugs, such as meropenem, 20 mg/(kg•times), once every 8 hours, for one week. For those with neutropenia, meropenem 20-40 mg/( kg•times), once every 8 hours, the course of treatment can be extended appropriately.
7. purulent meningitis : The first choice for HI purulent meningitis is ceftriaxone, 50 mg/(kg•times), once every 12 hours, or choose cefotaxime 50 mg/(kg•times), every 6 ~Once every 8 hours. Patients who are allergic to cephalosporins can consider the carbapenem antibacterial drug meropenem, 40 mg/(kg•times), once every 8 hours. The total course of treatment for children with uncomplicated and immunodeficiency is 10-14 days, or use 5-7 days after cerebrospinal fluid becomes normal. Complications such as subdural effusion or empyema should be extended appropriately. In the guidelines for the diagnosis and treatment of acute bacterial meningitis developed by the European Association of Clinical Microbiology and Infectious Diseases, it is recommended that ceftriaxone or cefotaxime combined with meropenem should be selected for patients with β-lactamase-negative ampicillin-resistant HI.
glucocorticoid application: it is recommended to give dexamethasone 0.15 mg/kg intravenously before or at the same time of the first administration of antibacterial drugs, once every 8 hours, for 3 to 5 consecutive days , It is beneficial to inhibit inflammatory response and reduce hearing damage caused by HI meningitis.
Immunotherapy
Vaccination is an effective means to prevent HI infection in children.The only available HI vaccine at present is Hib vaccine. Commonly used products are Hib vaccine, Hib-pertussis, diphtheria, tetanus (abbreviated as Diphtheria) quadruple vaccine, Hib-Diphtheria-Poliomyelitis The five-group vaccine is vaccinated at the age of 2, 3, and 4 months; the Hib-meningococcal type A and C triple vaccines can also be vaccinated at the age of 3, 4 and 5 months, which has immune protection against Hib infection. There is currently no vaccine product to prevent NTHi infection. The 10-valent pneumococcal polysaccharide-protein conjugate vaccine uses HI outer membrane protein D as the carrier protein. Studies have found that the 10-valent polysaccharide of pneumococcus. In areas covered by protein-binding vaccines, while streptococcus pneumoniae diseases have decreased, the infection rate of HI has also decreased significantly. After vaccination with pneumococcal 10-valent polysaccharide-protein conjugate vaccine, the level of antibodies against outer membrane protein D in children’s bodies is at a relatively high level, suggesting a high level of Conservative HI outer membrane protein is a candidate antigen and it is feasible to develop a capsular-type HI vaccine.
The above content is extracted from:
The Infection Group of the Pediatric Branch of the Chinese Medical Association, the Chinese Children's Infectious Diseases Etiology and Bacterial Resistance Surveillance Cooperative Group, the Editorial Committee of the Chinese Journal of Pediatrics. Expert advice on the diagnosis and treatment of children with Haemophilus influenzae infection [J]. Chinese Journal of Pediatrics, 2019,57(9):663-668.
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