From the Guidelines
Diphtheria treatment requires immediate medical attention and consists of both antitoxin and antibiotics. Diphtheria antitoxin should be administered as soon as possible, ideally within 48 hours of symptom onset, to neutralize the toxin produced by the bacteria, with a dosage of 5,000-10,000 units IM after appropriate testing for sensitivity 1. This is followed by antibiotics, typically penicillin or erythromycin, for 14 days to eliminate the bacteria. Some key points to consider in the treatment and management of diphtheria include:
- Patients require isolation until two negative cultures are obtained at least 24 hours apart.
- Supportive care is essential, including airway management if respiratory obstruction occurs due to the characteristic pseudomembrane formation.
- Close contacts should receive prophylactic antibiotics, such as an IM injection of benzathine penicillin or a 7- to 10-day course of oral erythromycin, and be monitored for symptoms 1.
- Vaccination status should be updated following recovery, as having diphtheria doesn't guarantee future immunity, with close contacts who have received less than three doses of diphtheria toxoid or whose vaccination status is unknown receiving an immediate dose of a diphtheria toxoid-containing preparation 1. This comprehensive approach is necessary because diphtheria produces a powerful exotoxin that can cause severe tissue damage and potentially fatal complications if left untreated.
From the FDA Drug Label
Diphtheria: Infections due to Corynebacterium diphtheriae, as an adjunct to antitoxin, to prevent establishment of carriers and to eradicate the organism in carriers. The treatment for diphtheria is erythromycin, used as an adjunct to antitoxin, to:
- Prevent establishment of carriers
- Eradicate the organism in carriers 2
From the Research
Treatment for Diphtheria
- The most effective treatment for diphtheria is the swift administration of diphtheria antitoxin (DAT) with conjunct antibiotic therapy 3.
- Diphtheria antitoxin (DAT) is an equine immunoglobulin preparation and is listed among the World Health Organization Essential Medicines 3.
- Early treatment with DAT is critical as the degree of protection is inversely proportional to the duration of the illness before its administration 4.
- The treatment for diphtheria can also include antimicrobial therapy to prevent further complications 5, 4.
Availability of Diphtheria Antitoxin
- DAT is in scarce supply and frequently unavailable to patients due to discontinued production in several countries, low economic viability, and high regulatory requirements for the safe manufacture of blood-derived products 3.
- The global access to DAT for both therapeutic and diagnostic applications seems inadequate, highlighting the need for accelerated research and development of alternatives 3.
- There is a need for a small stockpile of DAT to be centrally organized for all countries and to maintain an inventory of DAT availability within and between countries 3.
Clinical Management
- Clinical diagnosis of diphtheria is confirmed by the isolation and identification of the causative Corynebacterium spp., usually by bacterial culture followed by enzymatic and toxin detection tests 5.
- Clinical management of diphtheria cases requires preparedness for rare and re-emerging diseases, culturally safe environments, and addressing vaccine hesitancy 6.
- Public health responses to diphtheria cases should consider the capacity of regional health systems, access to necessary diagnostic laboratory resources, and up-to-date guidelines 6.