Eradication of Haemophilus Influenzae in Children with Cystic Fibrosis, Paediatrics (701)

Objectives

This guideline aims to provide guidance for the RHC CF Team in the management of children with Cystic Fibrosis (CF) who attend the RHC CF Unit and who culture Haemophilus influenza in respiratory secretions.

Background

The role of Haemophilus influenzae in the progression of CF lung disease is not well elucidated with recent studies however it has long been recognised as a pathogen with guidelines including NICE recommending 2-4 weeks of treatment orally on first isolation:

 “The importance of this infection has been disputed, but most CF clinics would regard it as a significant pathogen. There is increasing evidence that non-typeable H.influenzae can form biofilms, lending weight to the argument that it is of pathogenic significance. The aim of treatment is to eradicate H.influenzae infection and prevent chronic infection.... Suggested antibiotics include co-amoxiclav, or doxycycline... Resistance to amoxicillin is common.” ¹

Haemophilus influenzae ²

“For people with cystic fibrosis who develop a Haemophilus influenzae infection (diagnosed by a positive respiratory sample culture) but do not have clinical evidence of pulmonary infection, treat with an appropriate oral antibiotic.  For people with cystic fibrosis who develop a Haemophilus influenzae infection (diagnosed by a positive respiratory sample culture) and are unwell with clinical evidence of pulmonary infection, treat with an appropriate antibiotic, given orally or intravenously depending on the severity of the illness.”

In patients with CF, this organism is usually un-encapsulated (non-typeable) and therefore not covered by the H influenzae type b vaccine³.