13.2 Diphtheria
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Diphtheria | Crystalline penicillin (for cases) and Erythromycin (for contacts/less severe cases etc.) halts the bacterial growth, but cannot alter the toxic systemic impacts of the toxin. The drugs of choice are: Crystalline penicillin IV 1.5 lakh Units/Kg/day divided 6 hrly or in adults 20 lakh units 6 hrly for 14 days. Doses as high as 40 lakh units 6hrly have been used in exceptional circumstances. Erythromycin 40mg/kg/day divided 6 hrly, or in adults 500mg 6hrly orally after food for 14 days. Diphtheria antitoxin used in a single intravenous empirical dosage is the mainstay of treatment. Diphtheria antitoxin is given as IV infusion after test dose as per vial instructions. Dose is dependent on degree of general toxicity of the patient, site and size of membrane, and duration of illness (respiratory distress hemodynamic instability) | Adult: Erythromycin 500 mg 4 times a day for a 2-week duration For paediatric: Erythromycin 40- 50mg/kg/day in 4 divided doses times a day for a 2- week duration. Azithromycin 10 to 12 mg/kg OD for 7 days may be used instead of Erythromycin. For contacts: Erythromycin 40mg/Kg/day divided 6hrly or 250mg 6hrly after food for 10 days | The clinical manifestations of C diphtheriae infection are diverse and depend on factors such as the anatomical site of infection, the immune status of the host, and the production and systemic distribution of toxins. In suspected cases of diphtheria, antitoxin should be administered urgently based on clinical judgment without waiting for laboratory confirmation. After recovery patient should be given full course of DT vaccination. |
For common etiological agents of Diphtheria, see Annexure B.13.2
References
1. The Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th edition. CDC. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/index.html