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