Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae, primarily transmitted through respiratory droplets, which can lead to respiratory tract infections or skin lesions. The goal of treatment is to rapidly neutralize the toxin, eradicate the pathogen, and prevent complications. Standard therapy combines antitoxin and antibiotics to reduce mortality and the risk of sequelae. Early diagnosis and treatment are crucial to prevent severe complications such as myocarditis and neurological damage.
Main treatments include two major categories: 1. Antitoxin: derived from horse serum or human plasma preparations, capable of neutralizing unbound diphtheria toxin. 2. Antibiotics such as penicillin or erythromycin, which directly kill the bacteria. Both are used concurrently to block toxin activity and bacterial proliferation.
Suitable for patients with confirmed or highly suspected diphtheria, including: 1. Typical pharyngitis with grayish pseudomembrane formation 2. Skin ulcers with positive culture for C. diphtheriae 3. Contacts presenting with unexplained fever and cervical lymphadenopathy. Even if culture confirmation is not available, immediate treatment is recommended to avoid delays.
Antitoxin should be administered via intravenous or intramuscular injection, with adult doses typically ranging from 20,000 to 40,000 international units, adjusted according to severity. For antibiotics, penicillin is given at 50,000 units per kilogram per day, divided into 2-3 doses, for 10-14 days. Skin lesions require local debridement and systemic medication.
Antitoxin may cause allergic reactions, with severe cases potentially leading to anaphylactic shock. Common side effects of antibiotics include diarrhea and disruption of gut flora; prolonged use may lead to resistance. A minority of patients may develop anti-antitoxin antibodies (HRP), requiring close monitoring.
Contraindications: Patients with known hypersensitivity to horse serum or antibiotics should not receive treatment. Skin testing for allergy is recommended before use. Use during pregnancy requires risk-benefit assessment, and breastfeeding women should temporarily suspend breastfeeding. Patients with severe hepatic or renal impairment should have their antibiotic doses adjusted.
Concurrent use with anticoagulants may increase bleeding risk; combining with aminoglycoside antibiotics may enhance ototoxicity. Patients vaccinated against diphtheria should have their immune status re-evaluated after treatment, as antitoxin may neutralize vaccine antigens.
Timely treatment can reduce mortality from 10% to less than 1%, whereas untreated cases have a mortality rate of up to 20%. The combination of antitoxin and antibiotics established in the 1950s significantly decreased disease incidence. Epidemiological data show that completion of the full course correlates positively with recovery speed.
If allergic to horse serum antitoxin, human immunoglobulin preparations can be used as an alternative, though supply may be limited. In resource-poor areas, high-dose antibiotics alone may be used, with close monitoring of toxin-related symptoms. Severe cases may require intensive care support, such as respiratory assistance or cardiac monitoring.
During treatment, antitoxin should be administered first to neutralize bacterial toxins, followed by antibiotics (such as penicillin or erythromycin) to inhibit pathogen growth. Patients must strictly follow medical instructions to complete the entire course of antibiotics (usually 7-10 days), even if symptoms improve, to prevent bacterial resistance. If allergic to penicillin, the physician will prescribe alternative antibiotics and explain the options.
Is it normal to develop fever or redness/swelling after antitoxin administration? How should it be managed?Some patients may experience mild fever, redness, or swelling at the injection site as allergic reactions, which are usually normal immune responses and can be alleviated with antipyretics (such as acetaminophen) and cold compresses. If severe allergic reactions such as difficulty breathing or widespread skin rash occur, immediate medical evaluation is necessary, and antihistamines or steroids may be required. Persistent or worsening diarrhea during antibiotic treatment should be reported to the doctor for assessment of dysbiosis.
Should diet or daily activities be adjusted during treatment to promote recovery?During treatment, a high-protein, easily digestible diet such as rice porridge or steamed fish is recommended, avoiding irritant foods to reduce throat discomfort. Patients should rest completely until fever subsides and avoid strenuous activities to prevent increased oxygen demand and worsening airway obstruction. Discharges (such as sputum) should be properly disinfected to reduce transmission risk.
What follow-up examinations are necessary after completing acute treatment to confirm recovery?After discharge, a throat swab culture should be performed within 14 days to confirm the eradication of C. diphtheriae. If the initial test remains positive, the antibiotic course may need to be extended. The doctor will assess the risk of cardiac or neurological sequelae and may order ECG or neurological examinations. Isolation measures should continue until three consecutive cultures are negative, and contacts should have completed booster vaccinations.
Does the risk of future diphtheria infection decrease after treatment? What preventive measures should be taken?Even after recovery, unvaccinated individuals remain at risk of reinfection, as antitoxin provides only short-term immunity. It is recommended to complete three doses of diphtheria toxoid vaccine within six months after treatment to establish long-term immunity. Contacts should receive immediate vaccination or immunoglobulin injections. Daily precautions include avoiding contact with febrile respiratory symptoms and ensuring contacts are fully vaccinated to break the transmission chain.
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