Ophthalmologic Manifestations of Diphtheria Medication
- Author: Andrew A Dahl, MD; Chief Editor: Hampton Roy Sr, MD more...
Medication Summary
Treatment includes supportive care and isolation, as well as penicillin or erythromycin, which are extremely effective against C diphtheriae.
Diphtheria antitoxin, a hyperimmune antiserum produced in horses, protects against neurotoxicity when given within the first or second day of illness. Prevention is accomplished by immunization with formalin-inactivated toxin, usually given within first year of life.
Additional treatment of primary ocular infection includes topical erythromycin ointment, frequent manual removal of infected membranes, and ocular lubrication. Topical steroids may be used to reduce inflammation if no corneal ulceration is present.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Penicillin G benzathine (Bicillin LA)
Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. Effective treatment for systemic diphtheria.
Erythromycin
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes causing RNA-dependent protein synthesis to arrest.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose. Effective treatment for systemic diphtheria
Erythromycin ophthalmic (E-Mycin)
Indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections. For local control of diphtheric involvement of eye
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects.
Prednisolone acetate 1% ophthalmic drops (Pred Forte)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. To be used to minimize membrane formation and scarring. To reduce inflammation in the eye(s)
Sloan FA, Berman S, Rosenbaum S, Chalk RA, Giffin RB. The fragility of the U.S. vaccine supply. N Engl J Med. Dec 2 2004;351(23):2443-7. [Medline].
Burkhard C, Choi M, Wilhelm H. [Optic neuritis as a complication in preventive tetanus-diphtheria-poliomyelitis vaccination: a case report]. Klin Monbl Augenheilkd. Jan 2001;218(1):51-4. [Medline].
Chandler JW, Milam DF. Diphtheria corneal ulcers. Arch Ophthalmol. Jan 1978;96(1):53-6. [Medline].
Coachman J. Diphtheric conjunctivitis. Mer J Ophth. 1951;34:1176.
Dittmann S, Wharton M, Vitek C, et al. Successful control of epidemic diphtheria in the states of the Former Union of Soviet Socialist Republics: lessons learned. J Infect Dis. Feb 2000;181 Suppl 1:S10-22. [Medline].
Fuchs E. Textbook of Ophthalmology. 1889.
Hardy IR, Dittmann S, Sutter RW. Current situation and control strategies for resurgence of diphtheria in newly independent states of the former Soviet Union. Lancet. Jun 22 1996;347(9017):1739-44. [Medline].
[Best Evidence] Pichichero ME, Rennels MB, Edwards KM, et al. Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. JAMA. Jun 22 2005;293(24):3003-11. [Medline].
Rolleston JD. Diphtheric paralysis. Arch Pediatr. 1913;30:335-45.
Rolleston JD, Ronaldson GW. Acute Infectious Diseases. 1940.
Tharmaphornpilas P, Yoocharoan P, Prempree P, Youngpairoj S, Sriprasert P, Vitek CR. Diphtheria in Thailand in the 1990s. J Infect Dis. Oct 15 2001;184(8):1035-40. [Medline].
Walshe FMR. On the pathogenesis of diphtheric paralysis. Q J Med. 1918-19;12:14-37.

