How are diphtherial Corynebacterium infections treated?

Updated: Jun 14, 2019
  • Author: Lynda A Frassetto, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Since the early 1900s, diphtheria antitoxin (DAT), produced in horses, has been the mainstay of therapy. The antiserum works only to neutralize the toxin before it enters the cell. The antiserum is thought to be more effective in less severely ill patients and in those who are treated earlier in the disease course. Therefore, more severely ill patients and those with longer symptom duration are given higher doses than those with less severe disease of shorter duration. Whether this is an effective way of dosing the antiserum has never been tested.

Many people show signs of hypersensitivity reactions to the horse antiserum, and a test dose is usually given, with epinephrine available in case the patient has a severe reaction. However, because the mortality rate associated with antiserum has declined markedly, desensitization with increasing doses of antiserum is recommended.

Antibiotics treatment is the second arm of treatment. The goal is both to kill the organism and to terminate toxin production. Many antibiotics are effective, including penicillin, erythromycin, clindamycin, rifampin, and tetracycline; erythromycin or penicillin is the treatment of choice and is usually given for 14 days.

Supportive care is also important, including rest, airway management, observation for development of secondary lung infections, and management of cardiac and neurologic disease complications.


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