eMedicine Specialties > Infectious Diseases > Bacterial Infections

Corynebacterium Infections: Treatment & Medication

Author: Lynda A Frassetto, MD, Associate Clinical Professor, Department of Internal Medicine, University of California at San Francisco School of Medicine
Contributor Information and Disclosures

Updated: Jun 30, 2008

Treatment

Medical Care

For the initial office visit or emergency department treatment, see Diphtheria in the eMedicine Emergency Medicine section.

  • C diphtheriae
    • Since the early 1900s, diphtheria antitoxin (DAT), produced in horses, has been the mainstay of therapy. The antiserum works only to neutralize the toxin before it enters the cell. The antiserum is thought to be more effective in less severely ill patients and in those who are treated earlier in the disease course. Therefore, more severely ill patients and those with longer symptom duration are given higher doses than those with less severe disease of shorter duration. Whether this is an effective way of dosing the antiserum has never been tested.
    • Many people show signs of hypersensitivity reactions to the horse antiserum, and a test dose is usually given, with epinephrine available in case the patient has a severe reaction. However, because the mortality rate associated with antiserum has declined markedly, desensitization with increasing doses of antiserum is recommended.
    • Antibiotics treatment is the second arm of treatment. The goal is both to kill the organism and to terminate toxin production. Many antibiotics are effective, including penicillin, erythromycin, clindamycin, rifampin, and tetracycline; erythromycin or penicillin is the treatment of choice and is usually given for 14 days.
    • Supportive care is also important, including rest, airway management, observation for development of secondary lung infections, and management of cardiac and neurologic disease complications.
  • Diphtheroids
    • Antibiotics are the treatment of choice for nondiphtherial corynebacteria infections. Many species and groups are sensitive to various antibiotics, including penicillins, macrolide antibiotics, rifampin, and fluoroquinolones. However, antibiotic susceptibility can vary, and susceptibility testing is recommended. A review by Riegel et al on identification and antimicrobial sensitivity in 415 corynebacterial isolates from clinical specimens of patients hospitalized in Strasbourg, France, demonstrated that many species or groups were susceptible to ampicillin, cefotaxime, and rifampicin.24 Many species or groups were resistant to erythromycin, and 2 groups (ie, JK, C urealyticum) were resistant to nearly every drug tested.
    • Another review, by Spanik et al, examined risk factors for disease with corynebacteria.25 Of 123 episodes of breakthrough bacteremia during antibiotic prophylaxis in patients with cancer, 10% were from corynebacteria causing indwelling catheter infections. In this review, catheter removal and modification of antimicrobial therapy, depending on susceptibility testing, were independent risk factors for an improved outcome.

Surgical Care

The mainstay of treatment for these infections is nonsurgical. However, a case report discussed necrotizing lymphadenitis that was unresponsive to repeated antibiotic therapy, requiring surgical drainage and adequate debridement of the infected area.26

Consultations

  • The US Centers for Disease Control and Prevention (CDC) is the source for antitoxin (ie, DAT) in the United States. If treating suspected cases of diphtheria, contact the diphtheria duty officer at 404-639-8255 from 8 AM to 4:30 PM (EST) or at 404-639-2889 all other times.
  • Report all suspected cases of diphtheria to local and state health departments. Local infectious disease specialists who work with the CDC are available 24 hours a day through the local public health department for help with symptoms and disease management.
  • Cardiologists, pulmonary specialists, and neurologists may help in the care of patients who have specific disease complications.

Medication

For C diphtheriae infection, the therapy is antitoxin and antibiotic treatment. Many antibiotics are effective, including penicillin, erythromycin, clindamycin, rifampin, and tetracycline. Of recent concern are reports of penicillin tolerance among nontoxigenic C diphtheriae strains tested in Europe.27

For the nondiphtherial corynebacteria, antibiotic susceptibility testing is often required to determine the best treatment.

Booster treatment with diphtheria toxoid is also given often. Please see Deterrence/Prevention for a discussion of vaccinations with toxoid.

Antitoxins

These agents are administered to neutralize toxin responsible for diphtheria.


Diphtheria antitoxin (DAT)

Dose given depends on site of infection and length of time patient is symptomatic. In US, DAT available from CDC. Contact diphtheria duty officer at 404-639-8255 from 8 AM to 4:30 PM (EST) or at 404-639-2889 all other times. Report all suspected cases of diphtheria to local and state health departments.

Adult

Laryngeal or pharyngeal disease of <48 h duration: 20,000-40,000 U IV over 60 min
Nasopharyngeal infection: 40,000-60,000 U IV
Extensive disease of >3 d duration or any patient with neck swelling: 80,000-100,000 U IV
May be given IM for mild-to-moderate disease
Test all patients with a 1:10-1:100 dilution of DAT SC; if an immediate reaction occurs, administer epinephrine; hypersensitivity to horse serum not contraindication to antitoxin injection; desensitize subjects with increasing doses of diluted DAT

Pediatric

Administer as in adults

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

Approximately 10% of patients may develop serum sickness; hypersensitivity reactions can include anaphylaxis, requiring epinephrine treatment

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Erythromycin (E.E.S., E-Mycin, Ery-Tab)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections. In children, age, weight, and severity of infection determine proper dosage. When bid dosing desired, half of total daily dose may be taken q12h. For more severe infections, double dose. Parenteral erythromycin available as gluceptate or lactobionate. All PO dosage forms produce relatively similar effective base serum concentrations. Equivalent dosage of various formulations may be used for base.

Adult

500 mg PO/IV q6h for 14 d if tolerated

Pediatric

40-50 mg/kg/d PO/IV divided q6h for 14 d if tolerated

May increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; lovastatin and simvastatin increase 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; adverse GI effects common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur


Vancomycin (Vancocin)

Antibiotic useful against gram-positive organisms, particularly C jeikeium. Useful to treat septicemia, skin structure infections, and IV line infections/bacteremias.

Adult

1 g IV infused over 1 h q12h

Pediatric

40 mg/kg/d IV infused over 1 h divided q6h

Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; if taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants

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 renal failure; neutropenia; red man syndrome caused by IV infusion that is too rapid (dose given over few min) but rarely happens when dose given over 2 h or by PO route; red man syndrome not allergic reaction


Rifampin (Rifadin)

Nondiphtherial corynebacteria often are susceptible.

Adult

600 mg PO qd or divided bid

Pediatric

20 mg/kg PO qd or divided bid; not to exceed 600 mg/d

Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; blood pressure may increase with coadministration of enalapril; coadministration with isoniazid may result in higher rate of hepatotoxicity than with either agent alone (discontinue one or both agents if alterations in LFTs occur)

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

Obtain CBC and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; high-dose intermittent therapy and interruption of therapy associated with thrombocytopenia, which is reversible with discontinuation of therapy as soon as purpura occurs; if treatment continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur; can cause reddish discoloration of urine, sweat, sputum, and tears; soft contact lenses may be permanently stained

More on Corynebacterium Infections

Overview: Corynebacterium Infections
Differential Diagnoses & Workup: Corynebacterium Infections
Treatment & Medication: Corynebacterium Infections
Follow-up: Corynebacterium Infections
Multimedia: Corynebacterium Infections
References
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Further Reading

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Keywords

Corynebacterium infection, corynebacterial infection, corynebacterial disease, diphtheria, diphtheroids, Corynebacterium diphtheriae, C diphtheriae, Corynebacterium ulcerans, C ulcerans, Corynebacterium pseudotuberculosis, C pseudotuberculosis, Corynebacterium ovis, C ovis, Corynebacterium pyogenes, C pyogenes, Corynebacterium haemolyticum, C haemolyticum, Corynebacterium aquaticum, C aquaticum, Corynebacterium pseudodiphtheriticum, C pseudodiphtheriticum, Corynebacterium hofmannii, C hofmannii, Corynebacterium urealyticum, C urealyticum, Corynebacterium jeikeium, C jeikeium, Corynebacterium renale, C renale, Corynebacterium cystidis, C cystidis, Corynebacterium pilosum, C pilosum, Corynebacterium bovis, C bovis, Corynebacterium striatum, C striatum, Corynebacterium xerosis, C xerosis, Corynebacterium seminale, C seminale, Corynebacterium macginleyi, C macginleyi

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Contributor Information and Disclosures

Author

Lynda A Frassetto, MD, Associate Clinical Professor, Department of Internal Medicine, University of California at San Francisco School of Medicine
Lynda A Frassetto, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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