Anti-diphtheria serum is an effective anti-diphtheria drug that is obtained from horse blood (previously these animals are immunized with diphtheria toxoid). After isolation of serum by enzymatic hydrolysis, it is purified and concentrated.
Structure
As mentioned above, anti-diphtheria serum contains a protein fraction (specific immunoglobulins) extracted from horse blood serum (animals previously hyperimmunized with diphtheria toxoid), concentrated and purified using salt fractionation and peptic digestion.
This product is a transparent, slightly opalescent, yellowish or transparent liquid that does not have a precipitate.
In addition to the main ingredient, the product contains 0.1% chloroform as a preservative.
Immunobiological properties
1 ml of anti-diphtheria serum contains not less than 1500 IU (international antitoxic activity unit), which neutralizes the diphtheria bacterial toxin. The dosage of the drug depends on the form of the disease, the general condition of the patient and his age.
Indications
The use of antitoxic antidiphtheria serum is justified and highly effective in the development of various forms of diphtheria in adults or children.
Release Forms
Concentrated anti-diphtheria serum is packaged in 10 ml ampoules, in addition, the kit includes 1 ml ampoules, which are used for intradermal samples (the serum is diluted 1: 100). 10 ampoules are placed in the package.
The label of each ampoule is provided with the following information:
- the amount of ME;
- expiration dates;
- bottle and lot numbers;
- name of the drug;
- name of the institute and manufacturer (and their location);
- OBK number.
The same information should be applied to the packaging, in addition, it should contain information about the manufacturer (full name, address and ministry controlling it), name of the product in Latin, methods of use, as well as storage conditions.
Store serum in a dark, dry place at a temperature of 3-10 degrees. A drug that was frozen and subsequently thawed, but did not change its physical properties, is considered suitable.
In case of turbidity, sedimentation or foreign matter (fibers, flakes) that do not break when shaken, serum is prohibited. In addition, it is also impossible to use the product in the absence of a label on it or with any damage to the ampoules.
Application rules
The introduction of antidiphtheria serum is possible both subcutaneously and intramuscularly in the buttock (outer upper quadrant) or in the thigh (upper third of its front surface).
Before use, the ampoule with serum should be carefully checked. Injection, as a rule, is carried out by a doctor, but it can also be performed by paramedical staff, but exclusively under the supervision of a doctor.
Administration of diphtheria serum according to the method
Before using the serum, the patient's sensitivity to the horse (heterogeneous) protein should be determined, which is carried out using an intradermal test with a serum in a dilution of 1 to 100, which comes with the main drug. This test is carried out with a syringe, which has a division of 0.1 ml, and a thin needle. Moreover, for each such sample, an individual needle and a separate syringe are used.
A test is performed as follows: diluted antidiphtheria serum according to the method Infrequently (0.1 ml) is injected intradermally into the forearm (into its flexion surface), after which the reaction is monitored for 20 minutes. A test is called negative, in which the diameter of the emerging papule is less than 0.9 cm and there is a slight redness around it. A test is considered positive, in which the papule is more than 1 cm and the redness around it is significant.
In the case of a negative intradermal test, undiluted serum (0.1 ml) is injected under the skin, and if there is no reaction to it for 30 (up to 60) minutes, the entire required therapeutic dose is used.
If there is no diluted serum, then undiluted serum in the amount of 0.1 ml is injected under the skin of the forearm (into its flexion surface) and the reaction to it is evaluated 30 minutes after the injection.
If no reaction has occurred, an additional volume of serum in the amount of 0.2 ml is injected under the skin and is again observed, but for 1-1.5 hours. In the event of a successful outcome (lack of reaction), the entire therapeutic dose of diphtheria serum is administered.
If the intradermal test is positive or an anaphylactic reaction occurs , serum is used as therapy only in extreme cases (the presence of unconditional indications), very carefully, with the personal participation and control of a doctor. In this case, diluted serum is used (which is used for intradermal samples): first 0.5, then 2, and then 5 ml (the interval between injections is 20 minutes).
If a positive reaction does not occur, undiluted serum is injected subcutaneously in a volume of 0.1 ml and the patient's condition is monitored for half an hour. If there is no reaction at the same time, then an injection is carried out in the amount of the entire required therapeutic dose.
If it is impossible to use antidiphtheria serum due to the occurrence of positive reactions to any of the above doses, the therapeutic dose of serum should be administered under general anesthesia, having previously prepared syringes with 5% Ephedrine or Adrenaline (1 in 1000).
In the case of anaphylactic shock due to the introduction of serum from diphtheria, urgent adequate therapy is required: the use of ephedrine or adrenaline, analeptics, glucocorticosteroids, cardiac glycosides, calcium chloride, novocaine.
Serum
The effectiveness of serum from diphtheria directly depends on the correctly selected first, as well as course dosage and the earliest possible use of this drug after confirming the diagnosis.
- In the case of islet localized diphtheria of the pharynx (oral segment of the pharynx), the initial dosage is 10-15 thousand IU, and the course dosage is 10-20 thousand IU.
- In the case of the membranous form: from 15 to 30 thousand (first dose), and course - up to 40 thousand IU.
- With widespread diphtheria of the pharynx, the first dose of serum is 30-40 thousand IU, and the course, respectively, 50-60 thousand IU.
- In the case of the subtoxic form that developed in the oral segment of the pharynx, the dosage is 40-50 thousand, and the course dose is 60-80 thousand IU.
Diphtheria serum: administration algorithm for toxic form of pathology
- 1 degree - the initial dosage of 50-70 thousand IU, course 80-120 thousand IU;
- 2 degree - the initial dosage of 60-80 thousand IU, course 150-200 thousand IU;
- Grade 3 - the initial (first) dose of 100-200 thousand IU, course 250-350 thousand IU.
In the toxic form, serum should be used every 12 hours for 2-3 days, and then the dose and frequency of administration are adjusted in accordance with the dynamics of the disease. Moreover, in the first few days the patient is administered 2/3 of the course dosage.
- In case of hypertoxic diphtheria of the oral segment of the pharynx, the maximum dosage of the drug is prescribed. So, 1 dose is 100-150 thousand IU, and the course dose is not more than 450 thousand IU.
- In cases of localized croup: 1 dose - 30-40 thousand IU, and course 60-80 thousand IU.
- In cases of diphtheria localized in the nasal section of the pharynx, the doses are 15–20 thousand and 20–40 thousand IU (first and course dosages, respectively).
Localized Diphtheria Therapy
- With eye damage. The primary dosage is 10-15 thousand IU, course - 15-30 thousand IU.
- Lesions of genital diphtheria - 10-15 thousand IU, course - 15-30 thousand IU.
- Skin lesions: initial dose - 10 thousand IU, course - 10 thousand IU.
- Lesions of the nose: the first dose of 10-15 thousand IU, and the course - 20-30 thousand IU.
- Lesions of the navel: the initial dose is 10 thousand IU, and the course dose is also 10 thousand IU.
The number of injections with anti-diphtheria serum is prescribed depending on the clinical form of the pathology. For example, a single administration is prescribed to patients who have a localized or common form of diphtheria of the oral pharynx or nose.
If the disappearance of plaque does not occur within a day after the appointment of serum, then after 24 hours the drug is reused.
Serum withdrawal is carried out after a significant improvement in the patient's condition (the disappearance of edema of the cervical tissue, pharynx (its oral part), plaque and a decrease in intoxication).
Side effects
Can be:
- immediate (appear immediately after the use of serum);
- early (4-6 days after the use of the drug);
- distant (two or more weeks after the injection).
The following side effects may occur: hyperthermia (fever), skin rash, chills, disturbances in the functioning of the cardiovascular system, convulsions, and so on. Similar phenomena continue for no more than a few days. Collapse is rarely possible. In the event of the occurrence of such adverse effects, the appointment of timely adequate symptomatic therapy is necessary.