Medication Summary

For C diphtheriae infection, the therapy is antitoxin and antibiotic treatment. Many antibiotics previously were effective, including penicillin, erythromycin, clindamycin, rifampin, and tetracycline. More recently, resistance to penicillins, erythromycins, and clindamycin has been reported^{[60, 61]}; this is especially true for nontoxigenic C diphtheriae strains tested in Europe.^[62]

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.

Class Summary

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.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Prolonged therapy with multi-drug combinations may be necessary for infections with nondiphtherial corynebacteria.

Vancomycin (Vancocin)

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Antibiotic useful against gram-positive organisms; corynebacteria are very often susceptible. Useful to treat septicemia, skin structure infections, and IV line infections/bacteremias.

Rifampin (Rifadin)

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Nondiphtherial corynebacteria often are susceptible.

Linezolid (Zyvox)

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Linezolid prevents formation of the functional 70S initiation complex, which is essential for the bacterial translation process. It is bacteriostatic against enterococci and staphylococci and bactericidal against most strains of streptococci. Corynebacteria are very often susceptible.^[23]Linezolid is used as an alternative in patients allergic to vancomycin and for treatment of vancomycin-resistant enterococci.

Tetracycline (Sumycin, Actisite, Achromycin V)

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Tetracycline treats gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections. Corynebacteria are often susceptible.^[23]It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).

Tigecycline (Tygacil)

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Tigecycline is a glycylcycline antibiotic that is structurally similar to tetracycline antibiotics. It inhibits bacterial protein translation by binding to the 30S ribosomal subunit, and it blocks entry of amino-acyl tRNA molecules in ribosome A site.

It is indicated for complicated skin and skin structure infections caused by Escherichia coli, Enterococcus faecalis (vancomycin-susceptible isolates only), Staphylococcus aureus (methicillin-susceptible and methicillin-resistant isolates), Streptococcus agalactiae, Streptococcus anginosus grp (includes Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus), Streptococcus pyogenes, and Bacteroides fragilis. It is also generally effective against corynebacteria diphtheroids.^[45]

Clarithyromycin

Clarithryomycin belongs to the class of macrolide antibiotics, with a wide spectrum of activity against gram positive organisms - e.g., diphtheroids, staphylococcus, streptococcus - gram negative organisms, and anaerobic bacteria.

Questions

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Media Gallery

The corynebacterial tox gene is regulated by the corynebacterial iron-binding repressor, labeled DtxR. Binding of ferrous iron to the DtxR molecule forms a complex that binds to the tox gene operator and inhibits transcription. Depletion of iron from the system removes the repression and allows the toxin to be produced.
The characteristic thick membrane of diphtheria infection in the posterior pharynx.
Cervical edema and cervical lymphadenopathy from diphtheria infection produce a bullneck appearance in this child. Courtesy of Immunize.org, formerly Immunization Action Coalition (IAC) [https://www.immunize.org/].
Final case classification of corynebacteria infections. Courtesy of the World Health Organization (WHO) [Surveillance standards for vaccine-preventable diseases, 2nd ed, 2018, https://apps.who.int/iris/handle/10665/275754].

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Corynebacterium Infections Medication

Medication Summary

Antitoxins

Class Summary

Diphtheria antitoxin (DAT)

Antibiotics