Penicillin vs. Erythromycin in the Treatment of Diphtheria

Abstract

In an open-label, randomized trial, 44 Vietnamese children with diphtheria were given penicillin therapy (intramuscular benzylpenicillin, 50,000 U/[kg.d] for 5 days and then oral penicillin, 50 mg/[kg.d] for 5 days), and 42 were given erythromycin therapy (50 mg/[kg.d] orally for 10 days). There were no differences in times to membrane clearance or bacteriologic clearance, but median times to fever clearance were 27 hours (95% confidence interval [CI], 19-30; range, 0-124 hours) for penicillin recipients and 46 hours (95% CI, 34-54; range, 0-148 hours) for erythromycin recipients (P = .0004). In the penicillin group, acute treatment failed for one patient, and one patient relapsed. Three patients in the penicillin group developed diphtheritic myocarditis as evidenced by abnormal electrocardiograms. Erythromycin did not cause prolongation of the QT interval corrected for heart rate. Cultures of specimens from 15 patients (17.4%) were positive for toxigenic Corynebacterium diphtheriae. All isolates were susceptible to penicillin, but for isolates (27%), all of which were from patients who received penicillin treatment, were resistant to erythromycin (minimum inhibitory concentrations, > 64 mg/L). Penicillin is recommended as first-line treatment for diphtheria in Vietnam.

Canada's First Case of a Multidrug-Resistant Corynebacterium diphtheriae Strain, Isolated from a Skin Abscess

“…The strain was sensitive toward penicillin, meropenem, cefepime, vancomycin, daptomycin, gentamicin, and linezolid. Penicillin and erythromycin are recommended as treatment for diphtheria (10).…”

“…For instance, in Vietnam, 20% of isolates were found to be multiresistant to antibiotics when tested using disk diffusion and agar dilution methods (10). In a Brazilian study, 97% of C. diphtheriae strains were found to be resistant to between 4 and 7 antimicrobial drug classes using disk diffusion and Etest methods (14).…”

Diphtheria remains a threat to health in the developing world: an overview

“…In developing countries, high levels of vaccination of infants with diphtheria-tetanus toxoids-pertussis vaccine (DTP) Despite the widespread use of immunization, diphtheria remains endemic in several regions (Galazka & Robertson 1995) including Africa, India (Singh et al 1999), Bangladesh, Vietnam (Kneen et al 1998), the tropics and areas of South America (Cárdenas et al 1972, MacQueen 1997, including Brazil (Formiga 1985). Several countries where coverage has been high for 5-10 years have reported diphtheria outbreaks.…”

A Patient with Suspected Diphtheria

“…Diphtheriae is susceptible to antibiotics. Nowadays, penicillin and eritromicin are recommended by WHO (World Health Organization) to cure diphtheria (Kneen et al, 1998). Antibiotics are administered to the patients until they are able to swallow without feeling pain.…”

“…In a research, to early detect myocarditis diphtheria indicated by lengthen QT interval which causes ventricular arrhythmia, EKG with 12 lead serial can be performed as alternate say in 1 st -10 th day then continued given once a week after going out from the hospital (Kneen et al, 1998). A strict EKG monitoring is an indication to detect heart problem caused by diphtheria toxic, especially in the first week of illness (White, 2003).…”