5 Facts about diphtheria antitoxin, a new drug to treat diphtheria

Diphtheria is a disease caused by infection Corynebacterium diptheriae. In November 2017, the Indonesian Pediatrician Association (IDAI) stated that Indonesia was experiencing an outbreak (extraordinary event) of diphtheria which was marked by an increase in diphtheria cases in almost all regions in Indonesia.

These bacteria are transmitted through the air and can enter the respiratory tract. In the body, these bacteria will release toxins (toxic substances) that are harmful. Symptoms include weakness, sore throat, fever, swelling of the neck, pseudomembranous appearance, aka a gray layer in the throat or tonsils which when removed will bleed, difficulty breathing, and difficulty swallowing.

If you suspect diphtheria symptoms, you should see a doctor immediately. Currently, diphtheria treatment is carried out in two ways, namely:

Diphtheria antitoxin administration to prevent damage due to diphtheria toxin
Administration of antibiotics to fight bacteria

Everything you need to know about diphtheria antitoxin

1. Diphtheria antitoxin should be given as soon as possible

To increase the chances of a patient's cure, diphtheria antitoxin should be given as soon as possible. This antitoxin can even be given to patients before laboratory tests are carried out and the diagnosis is proven.

However, this antitoxin is only given to patients who are clinically showing diphtheria symptoms as mentioned above and after a hypersensitivity test to this antitoxin.

Although you don't need to wait for laboratory results, it doesn't mean you don't need to do any tests. You still need to do a biopsy (taking tissue samples) for further examination in the laboratory. This is useful to ensure you do not contract other infectious diseases.

2. How does diphtheria antitoxin work?

Antitoxins work by neutralizing toxins Corynebacterium diptheriae which is dislodged in the blood vessels (unbound) so as to prevent complications of the disease. This antitoxin comes from horse serum, that is, it is formulated from horse plasma which is immune to this disease.

3. Diphtheria antitoxin given in what form?

This antitoxin is usually given as an intramuscular injection (injection into the muscle) in milder cases of diphtheria. Whereas in severe cases, diphtheria antitoxin is usually given in intravenous fluids.

Diphtheria antitoxin doses for children and adults are generally no different. The dosage is adjusted according to the clinical symptoms that appear.

A sore throat that lasts two days is given 20,000 to 40,000 units
Nasopharyngeal disease is given from 40,000 to 60,000 units
Severe disease or patients with diffuse neck swelling are given 80,000 to 100,000 units
The skin lesions are administered from 20,000 to 100,000 units

4. Diphtheria antitoxin can be given as a preventive measure

According to the Centers for Disease Control and Prevention (CDC) in the United States (equivalent to the Directorate General of Disease Prevention and Control in Indonesia), there are several conditions in which diphtheria antitoxins can be used for disease prevention, not for treatment.

The following are people who may need antitoxin for diphtheria prevention.

People exposed to diphtheria toxin
People with an unclear history of diphtheria immunization (forgetting to have immunized Dt and Td or not)
Cannot be hospitalized to monitor the progress of clinical symptoms or tissue culture cannot be done to see diphtheria bacteria
People who have a history of or are suspected of being injected with diphtheria toxin (for example workers in laboratories or hospitals)

5. Antitoxin side effects that need to be watched out for

Like other medicines, antitoxins also have the risk of causing side effects. So, repeated administration is not recommended because it can increase the risk of side effects. Side effects that can appear after injection of diphtheria antitoxin include:

1. Allergies and anaphylactic shock

Allergy to antitoxins is generally characterized by itchy skin, redness, hives and angioedema. Meanwhile, in severe cases of allergies, namely anaphylactic shock, the symptoms are shortness of breath, drop in blood pressure, and arrhythmias. However, this case is very rare.

2. Fever

Fever can appear 20 minutes to one hour after injection of diphtheria antitoxin. Fever after injection is characterized by a rapid increase in body temperature accompanied by chills and tightness.

3. Serum sickness

This condition is characterized by symptoms of redness of the skin, hives, fever, accompanied by joint pain, stiffness, and enlarged lymph glands.

These symptoms can appear seven to ten days after administration of cerium antidifteria. Treatment for serum sickness is by giving anthistamine drugs, non-steroidal anti-inflammatory drugs, and corticosteroid drugs.