Diphtheria in Emergency Medicine Medication

  • Author: Allysia M Guy, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 14, 2011
 

Medication Summary

Patients with active disease as well as all close contacts should be treated with antibiotics. Treatment is most effective in the early stages of disease and decreases the transmissibility and improves the course of diphtheria. Additionally, close contacts, such as family members, household contacts, and potential carriers, must receive chemoprophylaxis regardless of immunization status or age. This entails treatment with erythromycin or penicillin for 14 days and post treatment cultures to confirm eradication.[3]

The CDC has approved macrolides such as erythromycin as first-line agents for patients older than 6 months of age. However, macrolide therapy has been associated with an increase in pyloric stenosis in children younger than 6 months, especially treatment with erythromycin. Intramuscular penicillin is recommended for patients who will be noncompliant or intolerant to an erythromycin course.

The horse serum antitoxin is given to anyone suspected to have diphtheria and can be administered without confirmation from cultures, as it is most efficacious early during the course of the disease.

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Antitoxins

Class Summary

Diphtheria antitoxin was first used in the United States in 1891, derived from a horse serum, it neutralizes unbound exotoxin. It is to be administered as soon as diphtheria suspected. It can only be obtained from the CDC and is not available internationally. Administer immunization toxoid booster, as the antitoxin does not influence immunity.

Diphtheria antitoxin

 

Neutralizes toxin before it enters cells. Dose given depends on site of infection and length of time patient is symptomatic. In United States, diphtheria antitoxin (DAT) is available from the 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.

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Macrolides

Class Summary

Erythromycin and penicillin are both recommended for the treatment of diphtheria. Some studies suggest that erythromycin may be better at eradication of the carrier state. Penicillin is recommended in household contacts who may not comply with the duration of erythromycin treatment. An increased incidence of pyloric stenosis is associated with administration of erythromycin to infants younger than 6 months. It is believed that azithromycin may be a better macrolide treatment in this population, though there are a few case reports describing pyloric stenosis in infants treated with azithromycin for pertussis infections.

The treatment of endocarditis requires the addition of an aminoglycoside.

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Erythromycin (E-Mycin, Ery-Tab)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

Age, weight, and severity of infection determine proper dosage in children. When bid dosing is desired, one half the total daily dose may be taken q12h. Double the dose for more severe infections.

Has the added advantage of being a good anti-inflammatory agent by inhibiting migration of polymorphonuclear leukocytes.

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Antibiotic, Penicillin

Class Summary

Penicillin may be used for treatment, prophylaxis, and eradication of diphtheria in carriers. However, resistant strains and transmission from penicillin-treated carriers has been reported.

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Penicillin G benzathine (Bicillin L-A, Permapen)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. Effective treatment for systemic diphtheria.

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Contributor Information and Disclosures
Author

Allysia M Guy, MD  Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven A Conrad, MD, PhD  Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Barry J Sheridan, DO  Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Elzbieta Pilat, MD, Lorenzo Paladino, MD, and Malini K Singh, MD, to the development and writing of this article.

The authors and editors of eMedicine gratefully acknowledge the medical review of this article by Joseph U Becker, MD.

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The characteristic thick membrane of diphtheria infection in the posterior pharynx.
Cervical edema and cervical lymphadenopathy from diphtheria infection produce a bull's neck appearance in this child. Source: Public Domain www.immunize.org/images/ca.d/ipcd1861/img0002.htm.
Photomicrograph depicts a number of gram-positive Corynebacterium diphtheriae bacteria, which had been stained using the methylene blue technique. The specimen was taken from a Pai's slant culture.
 
 
 
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