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By ULY CLINIC

 

Laryngeal Diphtheria

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Introduction

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Is an infection caused by Corynebacterium diphtheria; it is directly transmitted from person to person by droplets. Children between 1–5 years of age are most susceptible although non-immune adults are also at risk.  

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Diagnostic Criteria

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Diphtheria is characterized by grayish-white membrane, composed of dead cells, fibrin, leucocytes and red blood cells as a result of inflammation due to multiplying bacteria.  

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Non-Pharmacological Treatment

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  • Isolate the child

  • Gently examine the child’s throat – can cause airway obstruction if not carefully done.

  • NGT for feeding if unable to swallow

  • Avoid oxygen unless there is incipient airway obstruction

  • May need tracheostomy if there is incipient airway obstruction 

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Pharmacological Treatment:

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Drug of choice 

 

  • Penicillin V (250 mg four times daily) for a total treatment course of 14 days  

OR

  • Erythromycin (PO) 125–250 mg every 6 hourly for 14 days

OR

  • Azithromycin (PO) 500mg daily for 3 days  

OR

  • Penicillin G (Benzyl Penicillin) 25,000–50,000 units/kg to a maximum of 1.2 million units IV every 12 hours until the patient can take oral medicine) 

AND

  • Diphtheria antitoxin (IM or slow IV) dose depends upon the site and severity of infection:  

  • First give a test dose of 0.1ml of 1 in 10 dilution of antitoxin in 0.9% Sodium Chloride intradermal to detect hypersensitivity 

  • It should be given immediately because delay can lead to increased mortality

  • The dose should be administered intravenously over 60 minutes in order to inactivate toxin rapidly

  • 20,000–40,000 units for pharyngeal/laryngeal disease of <48 hours duration, 

  • 40,000–60,000 units for nasopharyngeal disease

  • 80,000–120,000 units for >3 days of illness or diffuse neck swelling ("bullneck")

 

Note: Tracheostomy may be required for airway obstruction

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Updated on, 2.11.2020

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References

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1. STG 

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