WHO releases 1st-ever guidance on clinical management of diphtheria

Geneva, Feb 15: In a first, the World Health Organization (WHO) has released guidance on the clinical management of diphtheria.

While previous available guidance was just an operational protocol, the new guidance followed the rigorous process for developing guidance at WHO.

It addresses the use of Diphtheria Antitoxin (DAT) in the treatment of diphtheria.

The guidance also includes new recommendations on antibiotics. In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) rather than penicillin antibiotics.

“This clinical practice guideline has been rapidly developed recognising the global increase in diphtheria outbreaks. Outbreaks of diphtheria in Nigeria, Guinea and neighbouring countries in 2023 have highlighted the urgent need for evidence-based clinical practice guidelines for the treatment of diphtheria,” the WHO said.

“Given the sporadic nature of outbreaks, many clinicians in the affected regions have never managed acute diphtheria and its related complications. Diphtheria remains a neglected disease and vaccination is the top priority. At the same time, for patients with diphtheria, access to antibiotics, DAT and supportive care can be lifesaving,” the agency noted.

Diphtheria is a disease caused by a bacterium that affects the upper respiratory tract and less often the skin. It also produces a toxin that damages the heart and the nerves.

It is a vaccine preventable disease, but multiple doses and booster doses are needed to produce and sustain immunity. People who are not immunised or under immunised are at risk of the disease.

Diphtheria is fatal in 5-10 per cent of cases, with a higher mortality rate in young children.

Recent diphtheria outbreaks stress the importance of sustaining high levels of vaccination coverage in communities across the life course.

In 2022, an estimated 84 per cent of children worldwide received the recommended 3 doses of diphtheria-containing vaccine during infancy, leaving 16 per cent with no or incomplete coverage. There is wide coverage variation between and within countries.