TY - JOUR
T1 - Penicillin vs. erythromycin in the treatment of diphtheria
AU - Kneen, Rachel
AU - Giao, Pham Ngoc
AU - Solomon, Tom
AU - Van, Tran Thi My
AU - Hoa, Nguyen Thi Tuyet
AU - Long, Tran Buu
AU - Wain, John
AU - Day, Nicholas P.J.
AU - Hien, Tran Tinh
AU - Parry, Christopher M.
AU - White, Nicholas J.
N1 - Funding Information:
Financial support: This work was funded by the Wellcome Trust of Great Britain.
PY - 1999/10
Y1 - 1999/10
N2 - 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 four 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.
AB - 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 four 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.
UR - http://www.scopus.com/inward/record.url?scp=2442748912&partnerID=8YFLogxK
U2 - 10.1086/514959
DO - 10.1086/514959
M3 - Article
C2 - 9798043
AN - SCOPUS:2442748912
SN - 1058-4838
VL - 27
SP - 845
EP - 850
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 4
ER -