[Moot questions and rarely employed means of treatment for severe forms of diphtheria in adults]. / O nekotorykh diskussionnykh voprosakh i redko primeniaemykh metodakh lecheniia tiazheloi formi difterii i ee oslozhnenii u vzroslykh.

The authors of the article consider the issue of employment of some treatment options for the grave forms of diphtheria and complications thereof in adult subjects to be a matter of debate and they report their experience gained with the use of rarely employed but efficient means of remediation. In diphtherial myocarditis concurrent with acute renal failure with a critical uncorrectable decline in myocardial contractility in spite of a progressive necrosis of the renal parenchyma due to an inadequate perfusion and toxic nephrosis an adrenomimetic drug (depamine) is to be prescribed. A ban on administration of glycosides is not to be regarded as a dogma. The question of their prescription needs to be decided on an individual basis with due regard to the duration of the illness, degree of cardiac decompensation, and whether it is conduction/contractility function disorders that prevail. Severe forms of diphtheria, including that complicated by myocarditis, especially concurrent with alcohol intoxication have been shown to be alleviated by intravenous administration of 0.015% sodium hypochlorite solution. In diphtheric polyneuritis it was anticholinesterase agents (neostigmine methylsulfate up to 6 mg daily) in maximum permissible doses that the authors employed in critical cases together with hyperbaric oxygenation and, as a means to improve metabolism,--lecithin and amniocen, a biological stimulant from human placenta.

Penicillin vs. erythromycin in the treatment of diphtheria.

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.

Carnitine supplementation in diphtheria.

We studied the effect of carnitine supplementation in patients with diphtheria. Six hundred and twenty five children of diphtheria received either DL-carnitine (100 mg/kg/day in two divided doses orally for four days), or no carnitine, in addition to the routine treatment for diphtheria. The patients receiving carnitine (n = 327) and controls (n = 298) were matched for age, sex, duration of symptoms, grade of toxemia and immunization status. Patients receiving carnitine showed a significant reduction in incidence of myocarditis as compared to controls (p = 0.001). Cases with myocarditis receiving carnitine therapy showed a significant reduction in mortality as compared to controls (p < 0.001). In view of a significant decline in incidence and mortality of myocarditis in cases of diphtheria, we recommended that all cases with diphtheria should receive carnitine supplementation.