{ "schema_version": 1, "kind": "condition", "id": "diphtheria", "name": "Diphtheria", "category": "chronic", "sources": "Diphtheria - StatPearls (NCBI Bookshelf NBK560911) - https://www.ncbi.nlm.nih.gov/books/NBK560911/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class RD10.00 - condition scope only, no dose · Diphtheria - disease-level clinical article (diphtheria-clinical.txt) · UK eMC Phenoxymethylpenicillin 250 mg Film-coated Tablets SmPC", "review_status": "reviewed", "verified_against": "Diphtheria - disease-level clinical article (diphtheria-clinical.txt) · UK eMC Phenoxymethylpenicillin 250 mg Film-coated Tablets SmPC", "verified_date": "2026-09", "treatments": [ { "id": 592, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "A toxin-mediated bacterial throat infection causing a pseudomembrane with risk of airway obstruction and myocarditis; rare in Egypt due to EPI vaccination coverage, but any suspected case needs immediate hospital referral for antitoxin and antibiotic treatment plus public health notification, since delay is dangerous.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "A toxin-mediated bacterial throat infection causing a pseudomembrane with risk of airway obstruction and myocarditis; rare in Egypt due to EPI vaccination coverage, but any suspected case needs immediate hospital referral for antitoxin and antibiotic treatment plus public health notification, since delay is dangerous.", "cautions": [ "Rare in Egyptian primary care.", "A notifiable public-health emergency: notify, isolate with droplet precautions, and refer the same day. The antitoxin and antibiotics below are what the receiving service gives, set out so the pathway is clear - they are not a reason to treat in the surgery and delay the referral.", "RED FLAG - Stridor or difficulty breathing means impending airway obstruction and is an emergency. A grey pseudomembrane on the tonsils or pharynx, or signs of myocarditis such as an irregular heartbeat or heart failure or of neuropathy, indicate complications: refer immediately." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same urgent pathway. The antibiotic is dosed by weight band and the antitoxin by clinical state, not per kilogram.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "diphtheria" }, { "id": 593, "generic": "Diphtheria antitoxin", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "Dose is set by the patient's clinical state and the severity of disease, not by weight; given intramuscularly or intravenously", "adult_duration": "single course", "dose_source": "Diphtheria - disease-level clinical article (diphtheria-clinical.txt)", "rationale": "The article makes antitoxin the primary treatment alongside antibiotics, and says to give it urgently on clinical judgement without waiting for laboratory confirmation.", "cautions": [ "RED FLAG - Give urgently on clinical suspicion. The antitoxin neutralises only unbound toxin and is ineffective once the toxin has bound to the cell membrane.", "Derived from horse antiserum. Hypersensitivity testing before administration, with drugs for anaphylaxis ready at the bedside.", "Notify the public health authority and isolate the patient with droplet precautions at the same time." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Same urgent pathway. The dose is set by clinical state and severity rather than by weight.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DIPHTHERIA ANTITOXIN 10000I.U. 10ML VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VACSERA", "price_egp": 413.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diphtheria" }, { "id": 594, "generic": "Penicillin G", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "600,000 units intramuscularly every 12 hours for a patient over 10 kg; switch to oral penicillin V once oral medication is tolerated", "adult_duration": "14 days in total, counting the oral switch", "dose_source": "Diphtheria - disease-level clinical article (diphtheria-clinical.txt)", "rationale": "The article names erythromycin or penicillin G the antibiotics of choice. In Egypt penicillin G is the one that is stocked.", "cautions": [ "Start antibiotics early to clear the organism, limit toxin release and stop spread to close contacts.", "Take cultures before starting antibiotics where that is feasible.", "If the organism is resistant, the article names linezolid or vancomycin as the alternatives.", "Post-exposure prophylaxis for close contacts and for staff exposed to respiratory secretions: a single intramuscular dose of penicillin G, 600,000 units under 6 years and 1.2 million units at 6 years and over; or oral erythromycin 500 mg four times daily for 7 to 10 days." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "By weight band, not per kilogram: 300,000 units intramuscularly every 12 hours at 10 kg or less; 600,000 units every 12 hours over 10 kg.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AQUA-PEN 1 M.I.U. VIAL.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > CID", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BENZYL PENICILLIN 1 M.I.U. B.P2004 VIAL.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diphtheria" }, { "id": 595, "generic": "Phenoxymethyl penicillin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "250 mg four times daily", "adult_duration": "2 weeks, the same course the injection started", "dose_source": "Diphtheria - disease-level clinical article (diphtheria-clinical.txt)", "rationale": "The article's oral step-down once the patient can take oral medication, completing the two-week course. It calls the drug penicillin V; the Egyptian register spells it phenoxymethyl penicillin, which is the same medicine.", "cautions": [ "No tablet on the Egyptian market delivers this dose whole. 250 mg is about 400,000 units (UK SmPC, Phenoxymethylpenicillin 250 mg tablets), so the marketed OSPEN 1.0 MIU and 1.5 MIU tablets are roughly 625 mg and 940 mg. The receiving service sets the practical dose.", "Toxigenic strains are considered non-contagious only after at least 48 hours of appropriate antibiotics.", "Confirm eradication with two consecutive negative cultures taken at least 24 hours apart after the course finishes.", "Egypt stocks the tablet only: OSPEN 1.0 and 1.5 MIU are marketed, and the 400,000 IU/5 mL suspension carries the (N/A) withdrawn marker, so there is no oral liquid on the market for a child who cannot swallow tablets." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric infectious-disease dosing.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "OSPEN 1.0 MIU 12 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ", "price_egp": 24.0, "pack_count": 12, "unit_price": 2.0, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OSPEN 1.5 MIU 12 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ", "price_egp": 41.0, "pack_count": 12, "unit_price": 3.42, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diphtheria" }, { "id": 596, "generic": "Erythromycin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "500 mg four times daily", "adult_duration": "14 days", "dose_source": "Diphtheria - disease-level clinical article (diphtheria-clinical.txt)", "rationale": "The article's other antibiotic of choice. Carried for completeness; see the caution on availability in Egypt.", "cautions": [ "Every oral erythromycin product in the Egyptian list carries the (N/A) suffix, meaning withdrawn - tablets, capsules and all six suspensions. Only topical acne preparations remain. The article names erythromycin first, but in Egypt penicillin G is the obtainable choice." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric infectious-disease dosing.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ERYTHROMYCIN STEARATE 250MG 10 F.C. TABS. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 6.5, "pack_count": 10, "unit_price": 0.65, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null }, { "trade_name": "ERYTHROCIN 500 MG 12 TABS. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 12.0, "pack_count": 12, "unit_price": 1.0, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null }, { "trade_name": "ERYTHROMYCIN STEARATE 500 MG 8 F.C. TAB. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 8.4, "pack_count": 8, "unit_price": 1.05, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null }, { "trade_name": "ERYTHROCIN 250 MG TAB. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 3.75, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null }, { "trade_name": "ERYTHROMYCIN 500 MG 12 ENTRIC C. TABS. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 11.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null } ], "condition_id": "diphtheria" } ] }