eMedicine Specialties > Ophthalmology > Infectious Disease

Diphtheria: Treatment & Medication

Author: Andrew A Dahl, MD, Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine
Contributor Information and Disclosures

Updated: Nov 17, 2008

Treatment

Medical Care

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 the illness. Prevention is accomplished by immunization with formalin-inactivated toxin, usually given within the 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.

Medication

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

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.

Adult

250 mg PO qid for 10 d
1,200,000 U/d IM for 10 d

Pediatric

<30 lb: 60 mg PO qid for 10 d; 300,000 U/d IM for 10 d
30-60 lb: 125 mg PO qid for 10 d; 600,000 U/d IM for 10 d
>60 lb: Administer as in adults

Probenecid can increase penicillin effectiveness by decreasing clearance; coadministration with tetracyclines can decrease effectiveness of penicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function


Erythromycin (EES, E-Mycin, Ery-Tab)

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

Adult

250 mg PO qid for 10 d

Pediatric

30-50 mg/kg/d PO in divided doses

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin, increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur


Erythromycin ophthalmic ointment 0.5% (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

Adult

Apply 0.5-inch (1.25 cm) ribbon to affected eye qid

Pediatric

Administer as in adults

Documented hypersensitivity; viral, mycobacterial, fungal infections of eye; patients using steroid combinations after uncomplicated removal of a foreign body from cornea should avoid using this product

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use topical antibiotics to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to a secondary infection (take appropriate measures if superinfection occurs)

Corticosteroids

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)

Adult

1 gtt OU bid/qid

Pediatric

Administer as in adults

Effects may decrease in patients taking phenytoin, barbiturates, and rifampin

Documented hypersensitivity; viral, fungal, or tubercular infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hypertension; known to cause cataract formation with long-term use; in prolonged use, withdraw treatment by gradually decreasing frequency of applications to avoid adrenal insufficiency

More on Diphtheria

Overview: Diphtheria
Differential Diagnoses & Workup: Diphtheria
Treatment & Medication: Diphtheria
Follow-up: Diphtheria
References
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References

  1. Burkhard C, Choi M, Wilhelm H. [Optic neuritis as a complication in preventive tetanus-diphtheria-poliomyelitis vaccination: a case report]. Klin Monatsbl Augenheilkd. Jan 2001;218(1):51-4. [Medline].

  2. Chandler JW, Milam DF. Diphtheria corneal ulcers. Arch Ophthalmol. Jan 1978;96(1):53-6. [Medline].

  3. Coachman J. Diphtheric conjunctivitis. Mer J Ophth. 1951;34:1176.

  4. 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].

  5. Fuchs E. Textbook of Ophthalmology. 1889.

  6. Hardy IR, Dittmann S, Sutter R. Current situation and control strategies for resurgence of diphtheria in Newly Independent States of the former Soviet Union. Lancet. 10/1996;347:1739-1744.

  7. [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].

  8. Rolleston JD. Diphtheric paralysis. Arch Pediatr. 1913;30:335-45.

  9. Rolleston JD, Ronaldson GW. Acute Infectious Diseases. 1940.

  10. Tharmaphornpilas P, Yoocharoan P, Prempree P, et al. Diphtheria in Thailand in the 1990s. J Infect Dis. Oct 15 2001;184(8):1035-40. [Medline].

  11. Walshe FMR. On the pathogenesis of diphtheric paralysis. Q J Med. 1918-19;12:14-37.

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Further Reading

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Keywords

diphtheria, conjunctivitis diphtheritica, Corynebacterium diphtheriae, C diphtheriae, keratoconjunctivitis, motility disorders, conjunctival infection, viral conjunctivitis, membranous conjunctivitis, immunization

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Contributor Information and Disclosures

Author

Andrew A Dahl, MD, Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine
Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Surgery, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic
Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Louis E Probst, MD, Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers
Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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