Laryngeal Diphtheria

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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. 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.

Non-pharmacological Treatment 

  • 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

Pharmacological Treatment:  Drug of choice  

A: phenoxymethylpenicillin (PO) 250mg 6hourly for 14days 

OR 

A: erythromycin (PO) 125–250mg 6hourly for 14days 

OR 

B: azithromycin (PO) 500mg 24hourly for 3days 

OR 

A:  benzyl  penicillin  (IV)  25,000–50,000units/kg  to  a  max.  of  1.2MU  12hourly  until  the patient can take oral medicine 

AND 

A: 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 60minutes 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 >3days of illness or diffuse neck swelling "bull-neck"

Note: Tracheostomy may be required for airway obstruction