A definitive diagnosis is based on compatible clinical findings and detection of C. diphtheriae or toxigenic C. ulcerans (by isolation or histologic identification) in local lesions.
- The laboratory should be notified that diphtheria is being considered, and appropriate selective media must be used.
- In the United States, respiratory diphtheria is a notifiable disease; cutaneous diphtheria is not.
Treatment: Diphtheria - Diphtheria antitoxin is the most important component of treatment and should be given as soon as possible. To obtain antitoxin, contact the Emergency Operations Center at the Centers for Disease Control and Prevention (CDC) (770-488-7100). See http://www.cdc.gov/diphtheria/dat.html for further information.
- Antibiotic therapy is administered for 14 days to prevent transmission to contacts. The recommended options are (1) procaine penicillin G (600,000 U IM q12h in adults; 12,500-25,000 U/kg IM q12h in children) until the pt can take oral penicillin V (125-250 mg qid); or (2) erythromycin (500 mg IV q6h in adults; 40-50 mg/kg per day IV in 2-4 divided doses in children) until the pt can take oral erythromycin (500 mg qid).
- - Rifampin and clindamycin are other options for pts who cannot tolerate penicillin or erythromycin.
- - Cultures should document eradication of the organism 1 and 14 days after completion of antibiotic therapy. If the organism is not eradicated after 2 weeks of therapy, an additional 10-day course followed by repeat cultures is recommended.
- Respiratory isolation and close monitoring of cardiac and respiratory functions should be instituted.
|