Diphtheria medical therapy: Difference between revisions
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{{Diphtheria}} | {{Diphtheria}} | ||
{{CMG}} {{AE}} {{KD}} | {{CMG}}; {{AE}}{{KD}}, {{DN}} | ||
==Overview== | |||
Treatment of [[diphtheria]] consists of the administration of the [[diphtheria]] [[antitoxin]] (if the disease is identified early), administration of the right [[antibiotic]] therapy, as well as the identification of individuals in close contact with the patient, so that they may be provided with the appropriate [[prophylaxis]].<ref name= "Bartlett">{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref name= "CDC">{{cite web | title = Diphtheria CDC| url =http://www.cdc.gov/vaccines/pubs/pinkbook/dip.html }}</ref><ref name="pmid19866893">{{cite journal |vauthors=Park WH, Atkinson JP |title=THE RELATION OF THE TOXICITY OF DIPHTHERIA TOXIN TO ITS NEUTRALIZING VALUE UPON ANTITOXIN AT DIFFERENT STAGES IN THE GROWTH OF CULTURE |journal=J. Exp. Med. |volume=3 |issue=4-5 |pages=513–32 |year=1898 |pmid=19866893 |pmc=2117979 |doi= |url=}}</ref><ref name="pmid9798043">{{cite journal |vauthors=Kneen R, Pham NG, Solomon T, Tran TM, Nguyen TT, Tran BL, Wain J, Day NP, Tran TH, Parry CM, White NJ |title=Penicillin vs. erythromycin in the treatment of diphtheria |journal=Clin. Infect. Dis. |volume=27 |issue=4 |pages=845–50 |year=1998 |pmid=9798043 |doi= |url=}}</ref><ref name="pmid15828187">{{cite journal |vauthors=Miller LW, Bickham S, Jones WL, Heather CD, Morris RH |title=Diphtheria carriers and the effect of erythromycin therapy |journal=Antimicrob. Agents Chemother. |volume=6 |issue=2 |pages=166–9 |year=1974 |pmid=15828187 |pmc=444622 |doi= |url=}}</ref><ref name="pmid8448320">{{cite journal |vauthors=Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ, Cochi SL |title=Fatal respiratory disease due to Corynebacterium diphtheriae: case report and review of guidelines for management, investigation, and control |journal=Clin. Infect. Dis. |volume=16 |issue=1 |pages=59–68 |year=1993 |pmid=8448320 |doi= |url=}}</ref> | |||
==Medical Therapy== | ==Medical Therapy== | ||
Treatment of [[diphtheria]] consists of the administration of the [[diphtheria]] [[antitoxin]] (if the disease is identified early), administration of the right [[antibiotic]] therapy, as well as the identification of individuals in close contact with the patient, so that they may be provided with the appropriate [[prophylaxis]].<ref name= "Bartlett">{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref name= "CDC">{{cite web | title = Diphtheria CDC| url =http://www.cdc.gov/vaccines/pubs/pinkbook/dip.html }}</ref><ref name="pmid19866893">{{cite journal |vauthors=Park WH, Atkinson JP |title=THE RELATION OF THE TOXICITY OF DIPHTHERIA TOXIN TO ITS NEUTRALIZING VALUE UPON ANTITOXIN AT DIFFERENT STAGES IN THE GROWTH OF CULTURE |journal=J. Exp. Med. |volume=3 |issue=4-5 |pages=513–32 |year=1898 |pmid=19866893 |pmc=2117979 |doi= |url=}}</ref><ref name="pmid9798043">{{cite journal |vauthors=Kneen R, Pham NG, Solomon T, Tran TM, Nguyen TT, Tran BL, Wain J, Day NP, Tran TH, Parry CM, White NJ |title=Penicillin vs. erythromycin in the treatment of diphtheria |journal=Clin. Infect. Dis. |volume=27 |issue=4 |pages=845–50 |year=1998 |pmid=9798043 |doi= |url=}}</ref><ref name="pmid15828187">{{cite journal |vauthors=Miller LW, Bickham S, Jones WL, Heather CD, Morris RH |title=Diphtheria carriers and the effect of erythromycin therapy |journal=Antimicrob. Agents Chemother. |volume=6 |issue=2 |pages=166–9 |year=1974 |pmid=15828187 |pmc=444622 |doi= |url=}}</ref><ref name="pmid8448320">{{cite journal |vauthors=Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ, Cochi SL |title=Fatal respiratory disease due to Corynebacterium diphtheriae: case report and review of guidelines for management, investigation, and control |journal=Clin. Infect. Dis. |volume=16 |issue=1 |pages=59–68 |year=1993 |pmid=8448320 |doi= |url=}}</ref> | |||
::* 1. '''Antitoxin ''' | |||
:::* 1.1 '''Pharyngeal disease <48 hrs''' | |||
::::* Preferred regimen: 20,000-40,000 U IV/IM | |||
:::* 1.2 '''Nasopharyngeal''' | |||
::::* Preferred regimen: 40-60,000 U IV/IM | |||
:::* 1.3 '''Extensive disease, or > 72 hrs''' | |||
::::* Preferred regimen: 80-120,000 U IV/IM | |||
:::* Note: IV administration may be suitable for severe disease | |||
* [[Erythromycin]] | |||
* [[Procaine penicillin G]] | ::* 2. '''Antibiotics ''' | ||
:::* Preferred regimen: [[Erythromycin]] 40 mg/kg/day (Maximum, 2 gm/day) PO/IV for 14 days | |||
:::* Alternative regimen: [[Procaine penicillin G]] 600,000 U/day IM qd for 14 days | |||
:::* Note: Procaine penicillin G 300,000 U/day for those who weigh 10 kg or less | |||
::* 3. '''Preventive antibiotic use''' | |||
:::* Note: For close contacts, especially household contacts, an age-appropriate diphtheria booster should be given | |||
:::* Preferred regimen: [[Benzathine penicillin G ]] | |||
::::* younger than 6 years old: 600,000 U IM | |||
::::* 6 years old and older: 1,200,000 U IM | |||
:::* Alternative regimen: [[Erythromycin]] | |||
::::* Adult: 1 g/day PO 7-10 days | |||
::::* Pediatric: 40 mg/kg/day PO 7-10 days | |||
:::* Note (1): If surveillance of contacts cannot be maintained, they should be given benzathine penicillin G | |||
:::* Note (2): Maintain close surveillance and begin antitoxin at the earliest signs of illness | |||
==References== | ==References== | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
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{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Pulmonology]] | |||
[[Category:Pediatrics]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 21:23, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2], Dima Nimri, M.D. [3]
Overview
Treatment of diphtheria consists of the administration of the diphtheria antitoxin (if the disease is identified early), administration of the right antibiotic therapy, as well as the identification of individuals in close contact with the patient, so that they may be provided with the appropriate prophylaxis.[1][2][3][4][5][6]
Medical Therapy
Treatment of diphtheria consists of the administration of the diphtheria antitoxin (if the disease is identified early), administration of the right antibiotic therapy, as well as the identification of individuals in close contact with the patient, so that they may be provided with the appropriate prophylaxis.[1][2][3][4][5][6]
- 1. Antitoxin
- 1.1 Pharyngeal disease <48 hrs
- Preferred regimen: 20,000-40,000 U IV/IM
- 1.2 Nasopharyngeal
- Preferred regimen: 40-60,000 U IV/IM
- 1.3 Extensive disease, or > 72 hrs
- Preferred regimen: 80-120,000 U IV/IM
- Note: IV administration may be suitable for severe disease
- 2. Antibiotics
- Preferred regimen: Erythromycin 40 mg/kg/day (Maximum, 2 gm/day) PO/IV for 14 days
- Alternative regimen: Procaine penicillin G 600,000 U/day IM qd for 14 days
- Note: Procaine penicillin G 300,000 U/day for those who weigh 10 kg or less
- 3. Preventive antibiotic use
- Note: For close contacts, especially household contacts, an age-appropriate diphtheria booster should be given
- Preferred regimen: Benzathine penicillin G
- younger than 6 years old: 600,000 U IM
- 6 years old and older: 1,200,000 U IM
- Alternative regimen: Erythromycin
- Adult: 1 g/day PO 7-10 days
- Pediatric: 40 mg/kg/day PO 7-10 days
- Note (1): If surveillance of contacts cannot be maintained, they should be given benzathine penicillin G
- Note (2): Maintain close surveillance and begin antitoxin at the earliest signs of illness
References
- ↑ 1.0 1.1 Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ 2.0 2.1 "Diphtheria CDC".
- ↑ 3.0 3.1 Park WH, Atkinson JP (1898). "THE RELATION OF THE TOXICITY OF DIPHTHERIA TOXIN TO ITS NEUTRALIZING VALUE UPON ANTITOXIN AT DIFFERENT STAGES IN THE GROWTH OF CULTURE". J. Exp. Med. 3 (4–5): 513–32. PMC 2117979. PMID 19866893.
- ↑ 4.0 4.1 Kneen R, Pham NG, Solomon T, Tran TM, Nguyen TT, Tran BL, Wain J, Day NP, Tran TH, Parry CM, White NJ (1998). "Penicillin vs. erythromycin in the treatment of diphtheria". Clin. Infect. Dis. 27 (4): 845–50. PMID 9798043.
- ↑ 5.0 5.1 Miller LW, Bickham S, Jones WL, Heather CD, Morris RH (1974). "Diphtheria carriers and the effect of erythromycin therapy". Antimicrob. Agents Chemother. 6 (2): 166–9. PMC 444622. PMID 15828187.
- ↑ 6.0 6.1 Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ, Cochi SL (1993). "Fatal respiratory disease due to Corynebacterium diphtheriae: case report and review of guidelines for management, investigation, and control". Clin. Infect. Dis. 16 (1): 59–68. PMID 8448320.