)
2
fraction of immunoglobulins
(serum neutralization in guinea pigs), 35 mg phenol and 10 mL 0.85 physiological solution.
Administration:
Do not use in case of turbidity or presence of precipitates.
Warm DAT before injection (maximum 34C).
For IV infusion, dilute each mL of antitoxin in 20 mL 0.9% NaCl or 5% dextrose
Do not exceed 1 mL per minute infusion rate.
Reactions: Can vary from mild asthma-like to full blown anaphylaxis. If the reaction is mild (i.e.
pruritis, edema and urticaria) interrupt the infusion, treat the reaction.
See The Alberta Immunization Manual for a more detailed description of Diphtheria Antitoxin and
reactions.
DAT Treatment for Cases
Give children and adults the same dose
Type of Diphtheria Dose
(units)
Route
(one time dose
*
)
Nasal 10,00020,000 IM
Tonsillar 15,00025,000 IM or slow IV
Pharyngeal or laryngeal 20,00040,000 IM or slow IV
Cutaneous 20,00040,000 IV
Combined types or delayed diagnosis
(or nasopharyngeal with membrane
present)
40,00060,000 IV
Extensive disease of 3 days duration
and/or severe swelling of neck (bull-
neck)
80,000120,000 IV
* additional doses may be warranted based on the persons symptoms and
response
Antibiotic Treatment for Cases
Age/weight Agent Dose Duration Route
< 9 kg (20 lbs) Procaine Pen G 300,000 U BID 14 days
1
IM
> 9 kg (20 lbs) Pen G 600,000 U BID 14 days
1
IM
When patient can swallow comfortably
Child
2
/Adult Penicillin V
OR
Erythromycin
125250 mg QID
OR
125500 mg QID
14 days
1
14 days
1
PO
PO
1 Total treatment time is 14 days (i.e. if taking IM antibiotic for 10 days would complete
treatment with 4 additional days of PO antibiotic)
2 Use a lower dose in children 6 years of age.
Alberta Health and Wellness
Public Health Notifiable Disease Management Guidelines
Diphtheria January 2011
ANNEX D: Antibiotic Prophylaxis for Contacts, and Treatment for Carriers
of Diphtheria (17;41;46)
Age Agent Dose Route Duration
< 6 years old
penicillin G
benzathine
OR
erythromycin
600,000 units
40 mg/kg in 4 divided
doses
IM
PO
One time
dose
710 days
> 6 years old
penicillin G
benzathine
OR
erythromycin
1.2 million units
1g/day in 4 divided doses
IM
PO
One time
dose
710 days
Note:
Diphtheria antitoxin has no proven role in the prophylaxis of contacts or the treatment of
carriers.
Contacts who cannot be kept under surveillance should receive penicillin G benzathine IM and
not erythromycin, because adherence to an oral regimen is less likely.
Identified carriers need swabs a minimum for two weeks following treatment and, if still
positive, should receive an additional 10 day course of oral erythromycin with further follow-up
cultures.
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ANNEX E (cont)
a. Routine practices, droplet precautions and contact precautions are described in detail at:
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/99pdf/cdr25s4e.pdf Maintain isolation until
elimination of the organism is demonstrated by negative culture of two samples obtained at least
24 hours apart after completion of antimicrobial therapy.
b. Both nasal and pharyngeal swabs should be obtained for culture.
c. The recommended dosage and route of administration depend on the extent and duration of
disease. Refer to Annex C for detailed recommendations for Diphtheria antitoxin.
d. Refer to Annex C for details regarding dosage recommendations for treatment of cases. Antibiotic
therapy is not a substitute for antitoxin treatment.
e. Immunizations required because clinical diphtheria does not confer immunity.
f. Close contacts include household members and other persons with a history of direct contact with
a case (e.g. caretakers, relatives, or friends who regularly visit the home) as well as health-care
personnel exposed to oral or respiratory secretions of a case. These individuals need to be
excluded from; children, occupations involving food handling and from school until their cultures
are negative for toxigenic diphtheria bacilli.
g. A single swab for culture should be obtained from each of the nasal and pharyngeal sites. Swabs
should also be taken from any wounds or skin lesions.
h. Refer to Annex D for detailed dosage recommendations for prophylaxis of contacts.
i. Refer to Annex D for detailed dosage recommendations for treatment of carriers.
j. In the respiratory form: elimination of C. diphtheria is demonstrated by two negative cultures of
throat and two negative cultures of the nasopharynx, taken at least 24 hours apart, a minimum of
two weeks after antibiotics are completed.
In the non-respiratory form: elimination C. diphtheria is demonstrated by two consecutive
cultures that are reported negative for toxigenic diphtheria bacilli. These cultures are to be taken
from skin lesions not less than 24 hours apart and a minimum of two weeks after completion of
antibiotic therapy. Persistent carriage of the organism should be treated with an additional 10 day
course of erythromycin with follow-up cultures.
k. Refer to the Alberta Immunization Manual for recommendations on the schedule of immunizations.
Alberta Health and Wellness
Public Health Notifiable Disease Management Guidelines
Diphtheria January 2011
ANNEX F: Countries with Endemic Diphtheria (52)
Regions Countries
Africa
Algeria, Angola, Egypt, Niger, Nigeria, Sudan, and sub-
Saharan countries
Americas
Bolivia, Brazil, Colombia, Dominican Republic, Ecuador,
Haiti, and Paraguay
Asia/South
Pacific
Afghanistan, Bangladesh, Bhutan, Burma (Myanmar), Cambodia,
China, India, Indonesia, Laos, Malaysia, Mongolia,
Nepal, Pakistan, Papua New Guinea, Philippines, Thailand,
and Vietnam
Middle East Iran, Iraq, Saudi Arabia, Syria, Turkey, and Yemen
Europe Albania, Russia, and countries of the former Soviet Union
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