What is the treatment for diphtheria tonsillitis?

Treatment for Diphtheria Tonsillitis

The treatment of diphtheria tonsillitis requires immediate administration of diphtheria antitoxin (DAT) combined with antimicrobial therapy, specifically erythromycin (40 mg/kg/day for children, 1 g/day for adults for 7-10 days) or benzathine penicillin (600,000 units for children <6 years, 1,200,000 units for those ≥6 years). 1

Immediate Management

1. Administer diphtheria antitoxin (DAT):

   • Must be given immediately upon clinical suspicion
   • Do not wait for laboratory confirmation as delay increases mortality 1
   • Requires sensitivity testing before administration due to risk of allergic reactions (7% risk of immediate hypersensitivity, 5% risk of serum sickness) 1

2. Initiate antimicrobial therapy concurrently with DAT:

   • First-line options:

     • Erythromycin: 40 mg/kg/day for children, 1 g/day for adults for 7-10 days 1, 2
     • Benzathine penicillin: Single IM injection of 600,000 units for children <6 years, 1,200,000 units for those ≥6 years 1

   • Erythromycin may be slightly more effective but benzathine penicillin offers guaranteed compliance with single-dose administration 1

Diagnostic Confirmation

• Obtain throat swabs or membrane samples before starting antibiotics if possible 1
• Isolation of Corynebacterium diphtheriae with toxigenicity testing is essential 1
• Collect serum specimen before antitoxin administration to support diagnosis (protective level is >0.01 IU/mL) 1

Monitoring and Follow-up

• Monitor for complications:

  • Airway compromise requiring possible intubation
  • Myocarditis
  • Neurological complications
  • Renal failure 1

• Perform repeat cultures after completion of antimicrobial therapy

• If cultures remain positive, administer an additional 10-day course of oral erythromycin 1

Contact Management

• Identify all close contacts (household members and those exposed to oral secretions)

• For all contacts regardless of vaccination status:

  • Obtain throat cultures
  • Provide antimicrobial prophylaxis (same regimens as for treatment)
  • Monitor daily for 7 days for signs of disease 1, 3

• Update vaccination status:

  • For contacts with <3 doses or unknown status: immediate dose plus completion of primary series
  • For contacts with ≥3 doses but no booster in past 5 years: administer booster dose 1, 3

Clinical Pitfalls and Caveats

• Delayed treatment significantly increases mortality - research shows fatal outcomes even with treatment when diagnosis is delayed 4
• DAT availability is limited globally - may need to contact health authorities urgently to source this essential medication 5
• Don't rely solely on antibiotics - while antibiotics halt toxin production, they cannot neutralize already circulating toxin, making antitoxin administration crucial 6, 4
• Don't wait for culture confirmation - clinical suspicion warrants immediate treatment with both DAT and antibiotics 1
• Don't overlook vaccination status - ensure patient receives appropriate vaccination after recovery 1

Diphtheria tonsillitis is a potentially fatal infection that requires rapid recognition and treatment to prevent systemic complications from diphtheria toxin, including myocarditis and neuropathy 7.