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Pediatric Diphtheria Medication

  • Author: Cem S Demirci, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Mar 10, 2016
 

Antibiotic agents

Class Summary

Antimicrobial therapy is indicated to halt toxin production, treat localized infection, and prevent transmission of the organism to patient contacts. C diphtheriae is usually susceptible to various agents in vitro, including penicillin, erythromycin, clindamycin, rifampin, and tetracycline. Resistance to erythromycin is common in closed populations if the drug has been used broadly.

Penicillin and erythromycin are only recommended for treatment. Erythromycin is marginally superior to penicillin for eradication of nasopharyngeal infection. Antibiotic therapy is not a substitute for antitoxin therapy. Elimination of the organism should be documented by at least 2 successive cultures from the nose and throat (or skin) obtained 24 h apart after completion of therapy. Treatment with erythromycin is repeated if culture results remain positive.

Penicillin G, aqueous crystalline (Pfizerpen)

 

Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Penicillin G procaine

 

Long-acting parenteral penicillin (IM only) to treat moderately severe infections caused by penicillin G–sensitive microorganisms.

Penicillin G benzathine (Bicillin L-A, Permapen)

 

Administered only IM. A tissue depot is created at the site of IM injection and slowly releases active drug into the systemic circulation. Penicillin serum concentrations are lower but more prolonged with the benzathine form than with the procaine form; serum levels of penicillin G are detected for as many as 30 d following administration.

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

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest.

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Antipyretic agents

Class Summary

These agents inhibit central synthesis and release of prostaglandins that mediate the effect of endogenous pyrogens in the hypothalamus; thus, they promote the return of the set-point temperature to normal.

Ibuprofen (Advil, Motrin)

 

One of the few NSAIDs indicated for reduction of fever.

Acetaminophen (Tylenol, FeverAll, Tempra)

 

Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

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Antitoxin

Class Summary

Antibodies are directed to a particular pathogen, usually in the form of antisera (from animal origin) or immunoglobulins. These agents are used for passive immunization resulting in immediate protection of short duration.

Antitoxin is the mainstay of therapy. It likely has no value in local manifestations of cutaneous diphtheria, but its use is prudent because toxic sequelae can occur, causing rapid deterioration of the patient. Follow with administration of appropriate diphtheria toxoid for active immunization during convalescence.

Diphtheria antitoxin

 

For passive transient protection against or treatment of diphtheria infections. Neutralizes only free toxin.

Only an equine preparation is available in the United States from Connaught Laboratories (Swiftwater, Pa) or from the CDC. Appropriate antibiotic therapy should be administered simultaneously with the antitoxin. Not recommended for asymptomatic carriers.

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Vaccines

Class Summary

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components that act as antigens. Administration of the vaccine stimulates the production of antibodies with specific protective properties.

Universal immunization is the only effective control measure. Diphtheria toxoid is typically combined with tetanus and acellular pertussis for children younger than 7 years. In children and adults, the immunization may be administered into deltoid or midlateral thigh muscles. In infants, the preferred site of administration is the midlateral thigh muscles. A specific formulation, Tdap, is recommended for adolescents and adults.[8, 9, 10, 11]

DTaP (Tripedia, Daptacel, Infanrix)

 

May be administered into deltoid or midlateral thigh muscles in children and adults. In infants, preferred site of administration is the midlateral thigh muscles.

Tdap (Adacel, Boostrix)

 

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. Promotes active immunity to diphtheria, tetanus, and pertussis by inducing production of specific neutralizing antibodies and antitoxins. Indicated for active booster immunization for tetanus, diphtheria, and pertussis prevention for persons aged 10-64 y (Adacel approved for ages 11-64 y, Boostrix approved for ages 10-18 y). Preferred vaccine for adolescents scheduled for booster.

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Contributor Information and Disclosures
Author

Cem S Demirci, MD Consulting Staff, Division of Endocrinology/Diabetes, Connecticut Children's Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Walid Abuhammour, MD, MBA, FAAP Professor of Pediatrics, Michigan State University College of Medicine; Director of Pediatric Infectious Disease, Department of Pediatrics, Al Jalila Children's Hospital

Walid Abuhammour, MD, MBA, FAAP is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur;Astra Zeneca;Novartis<br/>Consulting fees for: Sanofi Pasteur; Novartis; Merck; Astra Zeneca.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Ashir Kumar, MD, MBBS FAAP, Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS is a member of the following medical societies: Infectious Diseases Society of America, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

References
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