eMedicine Specialties > Ophthalmology > Infectious Disease
Diphtheria: Treatment & Medication
Updated: Nov 17, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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
Documented hypersensitivity
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
None reported
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
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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 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.
[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, et al. 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.
Further Reading
Keywords
diphtheria, conjunctivitis diphtheritica, Corynebacterium diphtheriae, C diphtheriae, keratoconjunctivitis, motility disorders, conjunctival infection, viral conjunctivitis, membranous conjunctivitis, immunization
Treatment & Medication: Diphtheria