Treatment for diphtheria

Treatment of diphtheria consists of the administration of antidiphtheria serum, which neutralizes the 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 administration of antidiphtheria serum is ineffective, and in some cases even harmful. In mild cases of the disease (localized, widespread form), diphtheria is treated only if the skin test results are negative. If the result is positive, the administration of serum should be avoided. In moderate and severe forms of diphtheria of the oropharynx, as well as in diphtheria of the respiratory tract, serum is mandatory, although in diphtheria of the respiratory tract the effect is less obvious. In case of a positive skin test, serum is administered in the intensive care unit after preliminary administration of glucocorticoids and antihistamines. The dose of serum and the route of administration depend on the severity of the disease. The serum is administered once intramuscularly and intravenously. In combined forms, the dose is increased by 20-30 thousand ME.

Serum dose for different forms of diphtheria

Form of diphtheria	Serum dose, thousand ME
Localized diphtheria of the oropharynx, nose, eyes, skin, genitals	10-20
Disseminated diphtheria of the oropharynx	20-30
Subtoxic diphtheria of the oropharynx	30-40
Toxic diphtheria stage I	30-50
Toxic diphtheria stage II	50-60
Toxic diphtheria stage III, hypertoxic diphtheria	60-80
Localized diphtheria of the respiratory system	10-20
Common descending diphtheria of the respiratory system	20-30

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

In moderate and severe forms, as well as in diphtheria of the respiratory tract, antibacterial treatment of diphtheria is prescribed for the fastest suppression of the pathogen: penicillins, cephalosporins, tetracycline drugs, macrolides, combination drugs (ampiox) - in average therapeutic doses for 5-8 days. 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, laryngeal stenosis), since patients with severe forms of the disease have pronounced immunosuppression and there is a high probability of developing bacterial complications.

In diphtheria of the respiratory tract, thermal and distracting procedures, inhalation, antihistamines, glucocorticoids, oxygen therapy are indicated. In case of progression of stenosis - tracheal intubation or tracheotomy. In case of descending croup, surgical treatment of diphtheria is ineffective, it must be supplemented with sanitation bronchoscopy to remove films.

In case of myocarditis, complete rest is necessary. Trimetazidine, meldonium, pentoxifylline are used. In case of polyneuropathy, bed rest, adequate nutrition are prescribed, in case of respiratory disorders - artificial ventilation, prevention of secondary infection.

Treatment of severe diphtheria should address the following issues:

• Dosage and route of administration of antidiphtheria serum;
• treatment of hypovolemia and DIC syndrome;
• antimediator effect;
• normalization of metabolism;
• elimination of various types of hypoxia (artificial ventilation);
• detoxification therapy;
• ensuring energy expenditure (adequate nutrition);
• rational antimicrobial therapy;
• immunocorrective therapy.

Diet and regimen for diphtheria

In the acute period of diphtheria and at later stages, if there are signs of damage to the heart and nervous system, bed rest is indicated. Depending on the patient's condition, table No. 10, tube or parenteral nutrition are used.

Approximate periods of incapacity for work

Approximate periods of disability vary greatly and are determined individually.

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Clinical examination

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

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How is diphtheria prevented?

Specific prophylaxis of diphtheria

Immunoprophylaxis is the main method of combating diphtheria. Scheduled vaccination against diphtheria and revaccination of the population, according to the national vaccination calendar, is carried out with vaccines containing adsorbed diphtheria toxoid (DPT, DPT-M, ADS-M, AD-M, as well as imported vaccines - tetracoccus, imovax polio).

Non-specific prophylaxis of diphtheria

Of great importance is the early detection and isolation of patients and carriers of toxigenic corynebacteria, their discharge after a double negative result of bacteriological examination of oropharyngeal discharge. In the team after the isolation of the patient, thermometry and daily medical examination are carried out for 7 days. Contacts with patients and carriers are examined bacteriologically once. In the focus after the isolation of the patient or carrier, final disinfection is carried out.

What is the prognosis for diphtheria?

Diphtheria has a favorable prognosis if diphtheria treatment is started promptly and antidiphtheria serum is administered promptly. A fatal outcome often occurs with late hospitalization and in individuals with an aggravated premorbid background (alcoholism, immunopathy).