Oral levofloxacin for the treatment of tracheobronchitis in a laryngectomee due to nontypeable Haemophilus influenzae

26 December, 2018

Oral levofloxacin was found to be effective for the treatment of beta-lactamase-producing nontypeable Haemophilus influenzae infection in a laryngectomee.

A 76-year-old Caucasian man presented with fever, sputum production and purulent conjunctivitis. The patient underwent laryngectomy 10 years ago and has since been wearing a heat and moisture exchanger (HME) filter that covers his stoma. His symptoms developed after a cold weather spell –he had to remove his HME on several occasions for extended periods of time to ease breathing. He received the current influenza virus vaccine 3 months prior and a pneumococcal polysaccharide vaccine 2 years ago.

Beta-lactamase-producing nontypeable H. influenzae was isolated from sputum and conjunctival culture, which was susceptible to levofloxacin and amoxicillin-clavulanate. The patient was treated with oral levofloxacin (500 mg/day), ciprofloxacin eye drops, acetaminophen, and guaifenesin. His conjunctivitis improved within 36 hours; fever subsided 48 hours after treatment; sputum production reduced but persisted for 5 days. The antimicrobial therapy was administered for 7 days; after which the patient recovered, and no recurrence of infection was observed in subsequent 8 months. Humidification of his trachea and airway was maintained by insertions of respiratory saline into the stoma while the patency of the airway was sustained by removal of mucus.

Laryngectomees are prone to bacterial tracheobronchitis due to H. influenzae – as described in this case report.¹ Nontypeable H. influenzae is known to cause community-acquired pneumonia in adults and invasive infections particularly in individuals with comorbidities – including coronary artery disease and lung disease.² Neonates and pregnant women are also more susceptible to nontypeable H. influenzae infections.

The exposure of the patient to the cold weather without HME had most likely compromised his airways leading to the infection. It was reported that non-HME users are at three times greater risk for contracting bronchitis, tracheobronchitis and pneumonia compared to HME users.³ Laryngectomees who have uncovered stoma are, therefore, at higher risk for lower respiratory infections particularly during winter.

While levofloxacin was shown to be effective for the treatment of nontypeable Haemophilus influenzae infection, at-risk individuals are advised to be vaccinated for respiratory pathogens including Streptococcus pneumoniae, H. influenzae, and the influenza viruses.