The World Health Organization (WHO) has issued new guidelines for the clinical management of diphtheria due to the urgent need for evidence-based practices, particularly in regions experiencing outbreaks.
Background
Diphtheria is a serious contagious bacterial infection primarily affecting the nose and throat. It is caused by strains of Corynebacterium diphtheriae and can lead to severe complications if left untreated, including airway compromise and systemic effects.
Importance of Guidelines
Given the sporadic nature of outbreaks and the lack of experience among clinicians in affected regions, evidence-based guidelines are crucial for effective management of diphtheria cases.
Key Recommendations
- Use of Diphtheria Antitoxin (DAT):
- Neutralization of unbound toxin with DAT is recommended.
- Routine sensitivity testing prior to DAT administration is not recommended.
- Escalating dosing regimen for DAT based on disease severity and time since symptom onset is suggested.
- Antibiotic Therapy:
- Macrolide antibiotics (azithromycin, erythromycin) are preferred over penicillin antibiotics.
- Antibiotics should be administered promptly alongside DAT to prevent further bacterial growth.
- Supportive Care:
- Monitoring and supportive care are essential to prevent and treat complications such as airway obstruction and myocarditis.
- Urgent airway intervention may be necessary in cases of imminent airway obstruction.
Rationale for Recommendations
- Macrolide antibiotics are preferred due to increasing resistance to penicillins and their efficacy in diphtheria treatment.
- Local antimicrobial susceptibility testing is recommended to ensure appropriate antibiotic selection.
Multiple Choice Questions (MCQs):
- What is the primary cause of diphtheria?
- A) Streptococcus pneumoniae
- B) Corynebacterium diphtheriae
- C) Haemophilus influenzae
- D) Neisseria meningitidis
- Answer: B) Corynebacterium diphtheriae
- Which type of antibiotics does WHO recommend for the treatment of diphtheria?
- A) Penicillin antibiotics
- B) Cephalosporin antibiotics
- C) Macrolide antibiotics
- D) Aminoglycoside antibiotics
- Answer: C) Macrolide antibiotics
- What is the recommended approach regarding sensitivity testing prior to administration of diphtheria antitoxin (DAT)?
- A) Routine sensitivity testing is recommended.
- B) Sensitivity testing should be performed only in severe cases.
- C) Sensitivity testing is not recommended.
- D) Sensitivity testing is recommended only in cases of antibiotic resistance.
- Answer: C) Sensitivity testing is not recommended.
- Why are macrolide antibiotics preferred over penicillin antibiotics for diphtheria treatment?
- A) They have a broader spectrum of activity.
- B) They are more cost-effective.
- C) There is increasing resistance to penicillins.
- D) They have fewer side effects.
- Answer: C) There is increasing resistance to penicillins.
- What is essential for ensuring appropriate antibiotic selection in diphtheria treatment?
- A) Routine administration of multiple antibiotics
- B) Prompt initiation of antibiotic therapy
- C) Local antimicrobial susceptibility testing
- D) Administration of broad-spectrum antibiotics
- Answer: C) Local antimicrobial susceptibility testing