LARYNGEAL DIPHTHERIA TREATMENT

On the slightest suspicion that a child is suffering from a diphtheritic laryngitis, the practitioner should immediately inject 8,000 units of antitoxin and 250 mg. of erythromycin estolate intramuscularly and arrange for the prompt removal of the patient to hospital. The steam kettle and the administration of 0-6 to 1-2 ml. (10 to 20 min.) of camphorated tincture of opium may be useful as temporary measures but, if rapid cure is not established, admission to hospital is essential for correct diagnosis and, when necessary, tracheostomy or intubation. Laryngo-Tracheo-Bronchitis.—The widespread practice of diphtheria immunization has resulted in the virtual disappearance of diphtheritic laryngitis ; and yet " croup " is still commonly encountered. The commonest form is that associated with a general inflammation of the respiratory tract. Although the condition is primarily a virus infection, secondary bacterial invaders are responsible for much of the subsequent damage. All ages may be affected, but because of the relatively small laryngeal opening in children, obstruction to respiration is usually confined to those under five years of age. In many cases Staph. pyogenes can be grown in pure culture from throat swabs. The organism has proved to be penicillin resistant in such a high proportion of cases that penicillin should never be the antibiotic of first choice. Since other bacteria may be involved, treatment should be started with a tetracycline while the results of sensitivity tests are awaited ; after more precise information is available, the suitable antibiotic can be chosen. Even after tracheostomy such cases often pursue a stormy course and require constant expert supervision.