For antibacterial treatment and immune prevention of children with Haemophilus influenzae infection, see expert advice!

Haemophilus influenzae (HI) infection is a common disease in children, clinically common with bacteremia, meningitis, pneumonia, otitis media, sinusitis and vulvovaginitis
.

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 formulate the "Children’s Haemophilus Influenza Diagnosis and Treatment Expert Recommendations", to make recommendations on the diagnosis of HI infection, anti-infective treatment strategies, and new thinking on vaccine prevention
.

In different areas of 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 administration of third-generation cephalosporins such as cefdinir or cefixime is recommended
.

Severe patients should be given intravenous medication.
The first choice is ceftriaxone, 50～80mg/(kg•times), 1 time/d, or cefotaxime 50 mg/(kg•times), once every 8 hours, the course of treatment is 5～7 d.
For patients with pulmonary complications such as empyema, the treatment course may be extended to 2 to 4 weeks or even longer as appropriate
.

For HI infections that are sensitive to macrolides, if children are allergic to penicillins and cephalosporins, azithromycin can be used as a second choice
.

HI that is sensitive to azithromycin may be resistant to clarithromycin.
The in vitro susceptibility results of the two are not completely consistent, and attention should be paid when choosing treatment 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, consider systemic treatment as appropriate, such as oral third-generation cephalosporins; in severe cases, consider intravenous infusion of ceftriaxone, cefotaxime and other third-generation cephalosporins.
The total course of treatment is no less than 7 d
.

Patients with clear HI infection and susceptibility to azithromycin may 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
.

The dose of azithromycin is 5-10 mg (kg•times), 1 time/d, the total amount is 30 mg/kg, 3-5 days is a course of treatment
.

3.
Acute sinusitis: The third-generation cephalosporin is the first choice for antibacterial drugs; in severe cases, intravenous infusion of ceftriaxone and cefotaxime may be considered as appropriate
.

The course of treatment is 7 days after the clinical symptoms are clearly controlled
.

4.
Conjunctivitis: Use 1 to 2 drops of levofloxacin eye drops during the day, once every 4 to 6 hours, and use levofloxacin eye 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 cleaning
.

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 amoxicillin orally.
Clavulanic acid, cefuroxime or third-generation cephalosporins
.

Patients with severe infections, especially those with concurrent respiratory 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; for severely ill patients Consider carbapenem antibacterial drugs, such as meropenem, 20 mg/(kg•times), once every 8 hours, for one week, and meropenem 20-40 mg/(kg•times with neutropenia) Times), once every 8 hours, the course of treatment can be extended appropriately
.

7.
Purulent meningitis: For HI purulent meningitis, ceftriaxone is the first choice, 50 mg/(kg•times), once every 12 hours, or cefotaxime 50 mg/(kg•times), every 6-8 hours.
Times
.

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 to 7 days after the cerebrospinal fluid is normal
.

If there are complications such as subdural effusion or empyema, the course of treatment 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
.

Application of glucocorticoids: It is recommended to give dexamethasone 0.
15 mg/kg intravenously before the first administration of antibacterial drugs or at the same time, once every 8 hours, for 3 to 5 consecutive days, which is beneficial to inhibit inflammation and reduce inflammation.
Hearing damage caused by HI meningitis
.

Immunization therapy vaccination is an effective means to prevent HI infection in children
.

The only HI vaccine currently available is the Hib vaccine.
Commonly used products include Hib vaccine, Hib-pertussis, diphtheria, and tetanus (diphtheria) quadruple vaccine, and Hib-diphtheria-Poliomyelitis quintuple vaccine.
Vaccination at 3, 4 months of age; Hib-meningococcal type A and C triple vaccines are also available.
Vaccination at 3, 4, and 5 months of age 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 to outer membrane protein D in children’s bodies is at a relatively high level.
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: Infectology Group of Pediatrics Branch of Chinese Medical Association, Chinese Children's Infectious Diseases Etiology and Bacterial Resistance Surveillance Cooperative Group, Chinese Journal of Pediatrics Editorial Committee.
Diagnosis and treatment of children with Haemophilus influenzae infection and expert advice[J].
Chinese Journal of Pediatrics, 2019, 57(9): 663-668.