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Can Hib Be Prevented and Are There Treatment Options?


What is Haemophilus Influenzae Type B (Hib)

Prior to the introduction of Hib vaccines, the majority of children acquired natural immunity to Hib through asymptomatic infection by five or six years of age. Newborns were also protected during the first several months of life due to the passage of maternal antibodies through the placenta and through breastfeeding.1

When a child is believed to have a serious invasive disease such as H. influenzae, hospitalization is usually required.2 Lab testing of blood or other bodily fluids, such as cerebrospinal fluid (CSF), is required to confirm the presence of H. influenzae, and to determine the particular type. 3

As strains of H. influenzae have become increasingly resistant to antibiotics such as ampicillin and amoxicillin,4 the current recommended treatment includes the use of an effective third generation cephalosporin such as ceftriaxone, until lab results determine the most effective antibiotic for use.5  An additional CDC recommended treatment option includes the use of ampicillin in conjunction with chloramphenicol. Antibiotic therapy for at least 10 days is generally recommended.6

In the case of meningitis associated with H. influenzae, intravenous or intramuscular administration of a third generation cephalosporin for seven days is currently the recommended course of treatment with adjustments made when lab results are known. For infants and children older than 2 months of age, the administration of intravenous dexamethasone is also recommended as it has been found to decrease inflammation and reduce the risk of neurological complications, including hearing loss. Additional supportive care may be necessary to manage complications that can include seizures, shock, syndrome of inappropriate antidiuretic hormone secretion (SIADH), subdural empyema (the collection of pus between the dura mater and the underlying arachnoid mater in the brain), and any secondary infections that may occur.7

The recommended treatment of H. influenzae cellulitis includes the use of either intravenous or intramuscular antibiotics until the fever decreases and the cellulitis diminishes. This is followed by an additional 7 to 10 day course of oral antibiotics. As other pathogens such as Staphylococcus aureus and Streptococcus pneumoniae may be responsible for the cellulitis, a broad spectrum antibiotic is generally used. In the case of orbital cellulitis, inpatient IV antibiotic treatment followed by one to three weeks of oral antibiotics is recommended.8 Surgery may also be required to drain the abscess if the swelling is severe.9

H. influenzae epiglottitis often involves the maintenance of an airway by intubation or tracheostomy. Ceftriaxone administered intravenously is recommended until the patient is able to swallow again. When indicated, intravenous antibiotics may be switched to oral antibiotics and continued for at least 7 days.10

Intravenous antibiotic treatment followed by 2 to 3 weeks of oral antibiotics is generally indicated in the treatment of H. influenzae arthritis. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood test results can help determine how long oral antibiotics should be taken.11 Surgery may also be required to prevent serious complications such as necrosis.12

H. influenzae bacteremia precedes nearly all other forms of invasive H. influenzae infections and between 30 to 50 percent of cases will develop into a more specific infection such as meningitis, pneumonia, or cellulitis. Lumbar punctures, additional blood cultures, and chest imagining is recommended to monitor for the risk of progression. Treatment of bacteremia involves the use of parenteral antibiotics, followed by the use of oral antibiotics.13

IMPORTANT NOTE: NVIC encourages you to become fully informed about Haemophilus Influenzae Type B (Hib) and the Hib vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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References

1 CDC Haemophilus influenzae type b – Pathogenesis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

2 CDC Haemophilus influenzae type B – Medical Management Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

3 CDC Haemophilus influenzae type B – Laboratory Diagnosis Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

4 Tristram S, Jacobs MR, Appelbaum PC  Antimicrobial Resistance in Haemophilus influenzae Clin Microbiol Rev. 2007 Apr; 20(2): 368–389.

5 Buensalido JAL Haemophilus Influenzae Infections Treatment & Management Medscape Sep. 7, 2018

6 CDC Haemophilus influenzae type B – Medical Management Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

7 Buensalido JAL Haemophilus Influenzae Infections Treatment & Management Medscape Sep. 7, 2018

8 Ibid

9 Buensalido JAL Haemophilus Influenzae Infections Medscape Sep. 7, 2018

10 Buensalido JAL Haemophilus Influenzae Infections Treatment & Management Medscape Sep. 7, 2018

11 Ibid

12 Buensalido JAL Haemophilus Influenzae Infections Medscape Sep. 7, 2018

13 Buensalido JAL Haemophilus Influenzae Infections Treatment & Management Medscape Sep. 7, 2018


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