Ampicillin-resistant Haemophilus influenzae. 2. Therapeutic considerations.

The increasing incidence of Haemophilus influenzae resistant to ampicillin has clinical implications not only for pediatricians but also for family physicians, because the bacterium is recognized more frequently as the etiologic agent for diseases in adults as well as in young children. Ampicillin is no longer the automatic choice for treatment of patients thought to have life-threatening H influenzae disease, and empiric treatment of otitis media must be reexamined. Chloramphenicol, as well as ampicillin, must be considered for the treatment of meningitis and other serious systemic H influenzae infections. Once the infective organism has been isolated and tested for resistance, ampicillin alone may be used if indicated or desired. Alternatives to ampicillin for middle ear infection are trimethoprim-sulfamethoxazole (Bactrim, Septra), erythromycin-sulfonamide (Pediazole), and cefaclor (Ceclor). Isolation and susceptibility tests are seldom done because they necessitate tympanocentesis.