PENICILLIN VS. ERYTHROMYCIN IN THE TREATMENT OF DIPHTHERIA

In an open-label, randomized trial, 44 Vietnamese children with diphth eria 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 pe nicillin recipients and 46 hours (95% CI, 34-54; range, 0-148 hours) f or erythromycin recipients (P =.0004), In the penicillin group, acute treatment failed for one patient, and one patient relapsed. Three pati ents in the penicillin group developed diphtheritic myocarditis as evi denced by abnormal electrocardiograms. Erythromycin did not cause prol ongation of the QT interval corrected for heart rate. Cultures of spec imens from 15 patients (17.4%) were positive for toxigenic Corynebacte rium diphtheriae, All isolates were susceptible to penicillin, but fou r isolates (27%), all of which were from patients who received penicil lin treatment, were resistant to erythromycin (minimum inhibitory conc entrations, >64 mg/L). Penicillin is recommended as first-line treatme nt for diphtheria in Vietnam.