Intramuscular ceftriaxone in the treatment of childhood meningitis due to Haemophilus influenzae type f

OBJECTIVE: TO describe a case of meningitis caused by Haemophilus influenza e type f (Hif) in a child. CASE SUMMARY: A 2.5-year-old white girl (18 kg) was hospitalized because of acute ataxia. The cerebrospinal fluid culture grew H. influenzas, which wa s later identified as type f. Therapy was limited by the inability to gain intravenous access. Treatment was initiated with dexamethasone 8 mg (0.44 m g/kg) intramuscularly, one dose on the day prior to initiation of ceftriaxo ne therapy, and intramuscular ceftriaxone 2 g (111 mg/kg/dose) once a day. After the first day, dexamethasone was administered at 3 mg (0.17 mg/kg/d) orally four times per day for four days. Within two days, the patient becam e afebrile and improved significantly. The remaining treatments were given during daily hospital visits on an outpatient basis. No complications occur red during the follow-up visits. DISCUSSION: The clinical presentation and therapeutic management of Hif men ingitis is similar to that of H. influenzas type b (Hib) meningitis. Factor s that may predispose a child to infections caused by Hif include upper res piratory tract infections, day care attendance, Down syndrome, and immunode ficiency. Hif meningitis usually is treated with a third-generation cephalo sporin (frequently ceftriaxone). Although most often administered intraveno usly, intramuscular ceftriaxone can provide a satisfactory clinical outcome in a child with adequate peripheral perfusion but limited intravenous acce ss. The majority of reported cases of Hii meningitis resolve with appropria te antibiotic therapy; however, long-ten neurologic sequelae occasionally o ccur. CONCLUSIONS: Hif occasionally causes pediatric meningitis. In a patient wit h good perfusion and difficult intravenous access, daily intramuscular admi nistration of ceftriaxone can be an effective treatment option. In this cas e, Hif meningitis occurred abruptly and resolved within 48 hours of initiat ion of ceftriaxone and dexamethasone without long-term sequelae, The risks of giving dexamethasone appear to be minimal, although efficacy for prevent ing Hif complications remains to be proven.