Laryngeal diphtheria

Laryngeal diphtheria

Laryngeal diphtheria is an infection caused by Corynebacterium diphtheriae. It is transmitted directly from person to person by respiratory droplets.

Children between 1–5 years of age are most susceptible, although non-immune adults are also at risk.

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

Non-pharmacological treatment

• Isolate the child.

• Gently examine the child's throat, as examination may cause airway obstruction if not carefully performed.

• Insert a nasogastric tube (NGT) for feeding if the child is unable to swallow.

• Avoid oxygen therapy unless there is incipient airway obstruction.

• Tracheostomy may be required if there is incipient airway obstruction.

Pharmacological treatment

Drug of choice

Phenoxymethylpenicillin

• Phenoxymethylpenicillin (PO) 250 mg every 6 hours for 14 days

OR

Erythromycin

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

OR

Azithromycin

• Azithromycin (PO) 500 mg every 24 hours for 3 days

OR

Benzyl penicillin

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

AND

Diphtheria antitoxin

• Diphtheria antitoxin (IM or slow IV)

The dose depends on the site and severity of infection.

Administration

• First give a test dose of 0.1 mL of a 1:10 dilution of antitoxin in 0.9% Sodium Chloride intradermally to detect hypersensitivity.

• The antitoxin should be given immediately because delay can increase mortality.

• The required dose should be administered intravenously over 60 minutes to inactivate toxin rapidly.

Dosage according to disease severity

Pharyngeal or laryngeal disease of less than 48 hours duration

• 20,000–40,000 units

Nasopharyngeal disease

• 40,000–60,000 units

Illness of more than 3 days duration or diffuse neck swelling ("bull-neck")

• 80,000–120,000 units