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Diphtheria treatment

All patients with diphtheria, regardless of the severity of the condition, must be hospitalized in an infectious diseases hospital.

The treatment is as follows:

Diet – fortified, high-calorie, carefully cooked food.

Etiotropic therapy (that is, aimed at eliminating the cause of the disease) – the introduction of anti-diphtheria serum (PDS), the dose and number of times of administration depend on the severity and form of the disease. With a mild form, PDS is administered once intramuscularly in a dose of 20–40 thousand IU, with a moderate form – 50–80 thousand IU once or, if necessary, repeatedly in the same dose after 24 hours. When treating a severe form of the disease, the total dose increases to 90–120 thousand IU or even up to 150 thousand IU (infectious-toxic shock, DIC). In this case, 2/3 of the dose is administered immediately, and during the first day of hospitalization, 3/4 of the total dose should be administered.

Antibiotics: with mild forms – erythromycin, rifampicin inside, with moderate and severe forms – injection of penicillins or cephalosporins. The course lasts 10-14 days. Antibiotics do not affect diphtheria toxin, but reduce the number of bacteria that produce it.

Local treatment – rinsing and irrigation with disinfectant solutions.

Detoxification therapy with glucose-salt solutions, taking into account the daily need for fluid and its losses (moderate and severe form).

Glucocorticosteroids – with moderate and severe forms.

The treatment of bacterial carriers is carried out with antibiotics: tetracyclines (children over 9 years old), erythromycin, cephalosporins against the background of general strengthening therapy and elimination of chronic foci of infection.

Complications
Among the most serious complications of diphtheria on the cardiovascular system, myocarditis, cardiac arrhythmias can be distinguished.

Neurological complications of diphtheria are caused by damage to various cranial and peripheral nerves and are manifested by accommodation paralysis, strabismus, paresis of the extremities, and in more severe cases, paralysis of the respiratory muscles and diaphragm muscles.

Secondary complications of diphtheria are such severe pathological conditions as acute cerebrovascular accident (thrombosis, embolism), metabolic encephalopathy, cerebral edema, toxic kidney damage, diphtheria hepatitis, as well as infectious toxic shock and DIC (desminated intravascular coagulation syndrome) violation of the coagulation system). The toxic form of diphtheria can lead to acute renal, cardiovascular, respiratory or multiple organ failure.

Non-specific complications of diphtheria are paratonsillar abscess, otitis media, pneumonia.

Vaccination
Diphtheria vaccination is carried out with an toxoid, i.e. an inactivated toxin. In response to its introduction, antibodies to diphtheria toxin are formed in the body, not against Corynebacterium diphteriae, but.

Diphtheria toxoid is a part of the combined domestic vaccine DTP (associated, that is, complex, vaccine against pertussis, diphtheria and tetanus), AaKDS (vaccine with acellular pertussis component) and DTP (diphtheria-tetanus toxoid), which are also “sparing” ADS-M vaccines and AD-M. In addition, SanofiPasteur vaccines were registered in Russia: Tetracocum (against diphtheria, tetanus, pertussis, poliomyelitis) and Tetraxim (against diphtheria, tetanus, pertussis, poliomyelitis, with cell-free pertussis component); D.T. Vax (diphtheria-tetanus toxoid for vaccination of children under the age of 6 years) and Imovaks D.T. Adjult (diphtheria-tetanus toxoid for vaccination of children over 6 years old and adults), as well as Pentaxim (vaccine against diphtheria, tetanus, pertussis, poliomyelitis and hemophilic infection with acellular pertussis component).

According to the Russian vaccination calendar, vaccination of children under the age of one year is carried out at 3, 4-5 and 6 months. The first revaccination is carried out at 18 months, the second at 7 years, the third at 14. Adults should be revaccinated from tetanus and diphtheria every 10 years.

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