Treatment of diphtheria

Treatment of diphtheria is the introduction of antidiphtheria serum, which neutralizes diphtheria toxin, circulating in the blood (therefore it is effective only in the early stages of the disease - in the first 2 days). After 3 days of illness, the introduction of antidiphtheria serum is ineffective, and in some cases even harmful. For a mild course of the disease (localized, common form), diphtheria treatment is performed only with negative skin test results. If the result is positive, you should abstain from the introduction of serum. With an average and severe form of diphtheria of the oropharynx, as well as in respiratory tract diphtheria, serum is administered necessarily, although with diphtheria of the respiratory tract, the effect is less pronounced. With a positive skin test, the serum is injected under the conditions of the resuscitation department after preliminary administration of glucocorticoids and antihistamines. The dose of serum and the route of administration depend on the severity of the course of the disease. Serum is administered once intramuscularly and intravenously. For combined forms, the dose. Increase by 20-30 thousand ME.

Serum dose for various forms of diphtheria

The form of diphtheria	Serum dose, thousand ME
Localized diphtheria of the oropharynx, nose, eye, skin, genital organs	10-20
Common oropharyngeal diphtheria	20-30
Subtoxic oropharyngeal diphtheria	30-40
Toxic diphtheria of the 1st degree	30-50
Toxic diphtheria of grade II	50-60
Toxic diphtheria of the third degree, hypertoxic diphtheria	60-80
Localized respiratory diphtheria	10-20
Common descending diphtheria of the respiratory system	20-30

Repeated serum administration and increased doses lead to increased and heavier heart and nervous system damage, as well as to serum sickness. The introduction of massive doses of serum (1 million IU or more) has an extremely negative effect on the patients' condition, since a huge amount of foreign protein enters the body that blocks the kidneys, provokes the development of respiratory distress syndrome and infectious-toxic shock, and DIC syndrome.

At moderate severity and severe forms, as well as in respiratory tract diphtheria, an antibacterial treatment of diphtheria is prescribed for the promptest suppression of the pathogen: penicillins, cephalosporins, tetracycline drugs, macrolides, combined preparations (ampiox) at medium therapeutic doses for 5-8 days. The detoxification treatment of diphtheria is carried out. In severe cases, plasmapheresis is indicated. Short-term use of glucocorticoids is advisable only for emergency indications (infectious-toxic shock, stenosis of the larynx), as in patients with severe forms of the disease immunosuppression is expressed and there is a high probability of development of bacterial complications.

Diphtheria of the respiratory tract shows thermal and distracting procedures, inhalation, antihistamines, glucocorticoids, oxygen therapy. With the progression of stenosis - intubation of the trachea or tracheotomy. With descending croup operative treatment of diphtheria is ineffective, it must be supplemented with sanative bronchoscopy to remove the films.

With myocarditis requires complete rest. Apply trimetazidine, meldonium, pentoxifylline. When polyneuropathy appoint bed rest, adequate nutrition, with respiratory disorders - ventilation, prevention of secondary infection.

Treatment of a heavy form of diphtheria should solve the following problems:

• dose and method of administering antidiphtheria serum;
• treatment of hypovolemia and DIC syndrome;
• anti-mediator effect;
• normalization of metabolism;
• elimination of various types of hypoxia (IVL);
• detoxification therapy;
• provision of energy expenditure (nutrition);
• rational antimicrobial therapy;
• immunocorrecting therapy.

Mode and diet for diphtheria

In the acute period of diphtheria and in later periods, if there are signs of damage to the heart and nervous system, bed rest is shown. Depending on the patient's condition, table number 10, probing or parenteral nutrition is used.

Approximate terms of incapacity for work

Approximate terms of incapacity for work vary greatly, they are determined individually.

[1], [2],

Clinical examination

The terms of observation of the patient are determined individually (but not less than 6 months).

[3], [4], [5], [6], [7], [8]

How is diphtheria prevented?

Specific prophylaxis of diphtheria

Immunoprophylaxis is the main method of controlling diphtheria. Planned vaccination against diphtheria and revaccination of the population, according to the national vaccination schedule, is carried out with vaccines containing adsorbed diphtheria toxoid (DTP, DTP-M, ADS-M, AD-M, and imported vaccines - tetracoc, imovax polio).

Nonspecific prevention of diphtheria

Importantly, early detection and isolation of patients and carriers of toxic corynebacteria, their discharge after a double negative result of bacteriological examination of the separated oropharynx. In the team after isolation of the patient for 7 days conduct thermometry and daily medical examination. Contacts with patients and carriers are examined once bacteriologically. In the hearth after isolation of the patient or carrier, the final disinfection is carried out.

What is the prognosis of diphtheria?

Diphtheria has a favorable prognosis if diphtheria treatment is started in time, and antidiphtheria serum is introduced on time. Lethal outcome often occurs with late hospitalization and in persons with a burdened premorbid background (alcoholism, immunopathy).