Hämophilus influenza non b

Question

Dear expert team,

my daughter (CF, nearly 3 years old) has always had Haemophilus influenzae non-B in the last three throat swabs in high germ counts. After the first finding of the germ, she got a broad antibiotic drug (Amoxicillin-trihydrate) for 2 weeks. 2 weeks after the end of the therapy she has had the next swab and again high germ counts of the mentioned germ were found. Now, after a pause of one month, she has it again (she has unambiguously an infection with fever, loss of appetite and cough and rhinitis) and takes since today again antibiotics (substance: cefaclor). What is the experience with Haemophilus influenza non-B? Can it come (similar to Pseudomonas aeruginosa) to a chronic (problemantic) colonization?

As she is not tolerating antibiotics well (she is often not eating at all, as she is feared of the food and has permanently consecutive infections due to the consecutively reduced immune defense), I ask myself, if there are other possibilities: probably phage therapy or similar things? Many thanks. M. and E.

Answer

Hello,

the finding of a germ in patients with CF but also in healthy children does not mean automatically that this has to be treated. Indeed, it is the sum of many observations, that should lead in the end to the initiation of a therapy. The first colonization with a germ will for sure be treated more intensively, than the chronic finding of a germ, that has found a niche in the lungs for already several years and cannot be eliminated anymore. Some germs are thought to be very important and we persue here an aggressive treatment regimen/ eradication therapy, like e.g. in case of Pseudomonas aeruginosa. Other germs are regarded more and more to be colonizing germs that cannot be avoided, and the aggressive therapy of those germs is mostly associated with resistances and the growing of other problematic germs. Such a germ is also Haeophilus influenzae type non-B. On the one hand, this germ can of course cause otitis media, sinusitis and also pneumonias, however there are many healthy children, who are also colonized with this germ. I would initiate an antibiotic therapy according to the clinical symptoms: secretions, cough, appetite, etc. However this is judged indeed differently by different CF experts.
The Phage therapy is not sufficiently validated in Europe. If probiotics as drops or other alternative therapeutic strategies play a role inhere, could be tried in the individual case. Many of my patients do this and are convinced by the effect of Manuka honey and others.
I thinks it is important to have a good co-work and discussion with your CF physician.

Best regards,
Dr. Olaf Eickmeier

26.07.2015