Nasopharyngeal Diphtheria with Extensive Pseudomembrane and Symptom Duration Under 48 Hours
Clinical Scenario
Nasopharyngeal involvement
Symptom onset < 48 h
This protocol applies to patients presenting with nasopharyngeal diphtheria in whom an extensive pseudomembrane is present and symptoms have been present for less than 48 hours. Early identification of this presentation is critical to timely intervention.
Treatment Approach
Management centres on the prompt combined use of a macrolide antibiotic together with diphtheria antitoxin (DAT). Antibiotic therapy must not be delayed. Where macrolide antibiotics are unavailable, an alternative may be considered based on susceptibility.
Specific agent selection, dosing, and antitoxin dose are defined in the full structured protocol.
References
- Nasopharyngeal disease (extensive pseudomembrane)
- Duration < 48 hours
- In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) in preference to penicillin antibiotics [Strong recommendation, low certainty evidence].
- Antibiotics should be administered alongside DAT and should not be delayed.
- In patients with suspected or confirmed symptomatic diphtheria, WHO suggests administration of a single dose of diphtheria antitoxin with choice of dose based on disease severity and time since symptom onset [Conditional recommendation, very low certainty evidence].
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