Acute epiglottitis: therapeutic consequences of change in the resistance of Haemophilus influenzae serotype B

From July 1977 to May 1987, 27 children with acute epiglottitis were treated in our intensive care unit. Haemophilus influenzae type b was identified by positive blood culture in 14 of 27 cases. Until 1983 the first 11 children were treated with ampicillin (100 mg/kg) for a mean duration of 10 days according to the standard therapeutic regimen and/or proven sensitivity from blood cultures (5 of 11 cases). The first finding of an ampicillin resistant Haemophilus influenza type b strain dates from January 1984. From this date on initial antibiotic therapy consisted of cefotaxime (100 mg/kg). Blood cultures proved good sensitivity to cefotaxime (100%) but an increasing rate of resistance to ampicillin (3 of 9 identified strains). Haemophilus influenzae septicemia in acute epiglottitis is verified by the isolation of Haemophilus influenzae type b from blood cultures (14/27) and the additional pneumonias (14/27). Additional meningitis as seen is a very rare complication. Facing these potentially life-threatening secondary foci of this invasive infection, an effective antibiotic therapy is mandatory. Our experiences confirm recommendations from US, UK, Australia, and Spain, where ampicillin was replaced by third generation cephalosporins as initial antibiotic therapy due to the increasing rate of resistance of Haemophilus influenzae type b.