Susceptibility of Haemophilus influenzae type b to rifampin and sulfisoxazole

Haemophilus influenzae: antibiotic susceptibility

Ampicillin resistance was first reported among clinical isolates of Haemophilus influenzae in 1972. Reports of chloramphenicol resistance followed shortly thereafter. The principal mechanism of resistance to these two antibiotics is enzymatic. Although other mechanisms have been described, they are found in comparatively few strains. The genetic information for the inactivating enzymes is plasmid mediated and therefore readily transmissible to susceptible strains. Consequently, effective therapy for invasive disease caused by this pathogen has been seriously compromised. As antibiotic susceptibility became less predictable, in vitro testing became increasingly important. Unfortunately, the standardization of methods for laboratory testing has been slow and complicated by the fastidious nature of the organisms. This review traces the development of antibiotic resistance in H. influenzae, discusses the mechanisms which appear to be important in mediating resistance, explores newer antimicrobial agents which might be useful in the treatment of infection, and analyzes the various approaches to in vitro testing.

Influence of growth medium and supplement on growth of Haemophilus influenzae and on antibacterial activity of several antibiotics

In the present study, five non-beta-lactamase- and five beta-lactamase-producing strains of Haemophilus influenzae were used to determine whether three different growth media, Mueller-Hinton broth and agar, brain heart infusion broth and agar, and tryptic soy broth and agar, and their added supplements (0.2% hemin-0.1% IsoVitaleX, 1% hemin-1% IsoVitaleX, 2% sheep blood, 10% Fildes enrichment, 5% Fildes enrichment, 1% supplement B, 5% horse erythrocytes, and 2% hemoglobin-1% IsoVitaleX) would influence the growth rate of this microorganism and the antibacterial activity of eight antibiotics, including ampicillin, tetracycline, chloramphenicol, gentamicin, cefamandole, erythromycin, trimethoprim-sulfamethoxazole (TMP-SMX), and cefoperazone. The growth curve studies were carried out with an initial inoculum of 10(4) bacteria per ml, and MICs were determined with an inoculum of 5 X 10(5) microorganisms. Mueller-Hinton broth, brain heart infusion broth, and tryptic soy broth enriched with 5% Fildes resulted in a maximal growth of more than 10(8) CFU/ml at 24 h. When 10% Fildes or 2% sheep blood was added as enrichment to Mueller-Hinton broth, a considerable reduction in the growth rate of H. influenzae strains resulted (P less than 0.01). Significant variations in MICs (P less than 0.01) were observed with chloramphenicol, TMP-SMX, erythromycin, and cefoperazone when brain heart infusion agar, Mueller-Hinton agar, or tryptic soy agar was used. Chloramphenicol, gentamicin, erythromycin, and TMP-SMX were all affected by the different enrichments added to Mueller-Hinton agar. MICs were in general higher with 5% Fildes enrichment and lower with 1% supplement B. Cefoperazone was the only drug which exhibited a lower MIC in 5% Fildes enrichment for ampicillin-resistant H. influenzae strains.

Rifampin alone or with trimethoprim for contacts of children with Haemophilus influenzae type b infections

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.