Anti-diphtheria serum is an effective anti-diphtheria drug that is obtained from horse blood (these animals are previously immunized with diphtheria toxoid). After whey is isolated by enzymatic hydrolysis, it is purified and concentrated.
Composition
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 by s alt fractionation and peptic digestion.
This remedy is a transparent, slightly opalescent, yellowish or transparent liquid that does not have a precipitate.
Besides the main ingredient, the product contains 0.1% chloroform as a preservative.
Immunobiological properties
1 ml of anti-diphtheria serum contains at least 1500 IU (international antitoxic activity unit), which neutralize diphtheria bacterial toxin. The dosage of the drug depends on the form of the disease, the general condition of the patient and hisage.
Indications
The use of antitoxic diphtheria serum is justified and highly effective in the development of various forms of diphtheria in adults or children.
Issue Forms
Concentrated diphtheria serum is packaged in 10 ml ampoules, in addition, 1 ml ampoules are included in the kit, which are used for intradermal tests (the serum is diluted 1:100 in them). The package contains 10 ampoules.
The label of each ampoule is provided with the following information:
- IU quantity;
- expiration dates;
- bottle and series numbers;
- drug name;
- name of institute and manufacturer (and their location);
- OC number.
The same information must be printed on the packaging, in addition, it must contain information about the manufacturer (full name, address and the ministry that controls it), the name of the product in Latin, methods of application, as well as conditions storage.
Store serum in a dark, dry place at a temperature of 3-10 degrees. A product that has been frozen and subsequently thawed without changing its physical properties is considered acceptable.
In case of turbidity, sedimentation or foreign inclusions (fibers, flakes) that do not break when shaken, it is forbidden to use whey. In addition, it is also impossible to use the product if there is no label on it or if the ampoules are damaged in any way.
Rules of application
Introductionantidiphtheria serum is possible both subcutaneously and intramuscularly in the buttock (outer upper quadrant) or in the thigh (upper third of its anterior surface).
Before using the serum ampoule should be carefully checked. The injection is usually performed by a doctor, but it can also be done by paramedics, but only under the supervision of a doctor.
Introduction of antidiphtheria serum according to the Bezrareko method
Before using serum, the patient's sensitivity to horse (heterogeneous) protein should be determined, which is carried out using an intradermal test with serum at a dilution of 1 to 100, which comes with the main drug. This test is carried out with a syringe that 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.
Perform the test as follows: diluted antidiphtheria serum according to the Bezredko method (0.1 ml) is injected into the forearm (into its flexor surface) intradermally, after which the reaction is monitored for 20 minutes. A test is called negative if the diameter of the emerging papule is less than 0.9 cm and there is slight redness around it. A test is considered positive if the papule is larger than 1 cm and the redness around it is significant.
In 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, applythe entire required therapeutic dose.
If there is no diluted serum available, then undiluted serum in the amount of 0.1 ml is injected under the skin of the forearm (into its flexor surface) and the reaction to it is evaluated 30 minutes after the injection.
If there is no reaction, an additional volume of serum in the amount of 0.2 ml is injected under the skin and observed again, but for 1-1.5 hours. In case of a favorable outcome (no reaction), the entire therapeutic dose of diphtheria antiserum is administered.
If the intradermal test is positive or an anaphylactic reaction occurs, serum as a therapy is used only in extreme cases (the presence of unconditional indications), very carefully, with the personal participation and control of the doctor. In this case, diluted serum is used (which is used for intradermal tests): first 0.5, then 2, and after 5 ml (the interval between injections is 20 minutes).
If a positive reaction does not occur, undiluted serum in a volume of 0.1 ml is injected subcutaneously and the patient's condition is observed for half an hour. If there is no reaction, then the injection is carried out in the amount of the entire required therapeutic dose.
If it is impossible to use anti-diphtheria serum due to the occurrence of positive reactions to any of the above doses, the therapeutic dose of serum should be administered under anesthesia, having previously prepared syringes with 5% "Ephedrine" or "Adrenaline" (1 to 1000).
In case of anaphylactic shock due toadministration of diphtheria serum, urgent adequate therapy is required: the use of ephedrine or adrenaline, analeptics, glucocorticosteroids, cardiac glycosides, calcium chloride, novocaine.
Applying Serum
The effectiveness of diphtheria serum directly depends on the correctly selected first, as well as the course dosage and the earliest possible use of this remedy after confirming the diagnosis.
- In the case of islet localized diphtheria of the pharynx (oral segment of the pharynx), the primary dosage is 10-15 thousand IU, and the course dose is 10-20 thousand IU.
- In the case of membranous form: from 15 to 30 thousand (first dose), and course - up to 40 thousand IU.
- With widespread diphtheria of the pharynx, the 1st dose of serum is 30-40 thousand IU, and the exchange dose, respectively, is 50-60 thousand IU.
- In the case of a subtoxic form that has developed in the oral segment of the pharynx, the dosage is 40-50 thousand, and the exchange rate is 60-80 thousand IU.
Anti-diphtheria serum: an algorithm for administration in the toxic form of pathology
- 1 degree - initial dosage 50-70 thousand IU, course 80-120 thousand IU;
- 2 degree - initial dosage 60-80 thousand IU, course 150-200 thousand IU;
- 3 degree - initial (first) dose 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. And in the firstfor several days, the patient is given 2/3 of the course dosage.
- In case of hypertoxic diphtheria of the oral segment of the pharynx, the maximum dosages of the drug are prescribed. So, 1 dose is 100-150 thousand IU, and the course dose is no 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 segment of the pharynx, the doses are 15-20 thousand and 20-40 thousand IU (first and course dosages, respectively).
Therapy for localized diphtheria
- When the eyes are affected. Primary dosage 10-15 thousand IU, course - 15-30 thousand IU.
- Diphtheria of the genital organs - 10-15 thousand IU, exchange rate - 15-30 thousand IU.
- Skin lesions: initial dose - 10 thousand IU, course - 10 thousand IU.
- Nose lesions: first dose 10-15 thousand IU, and course - 20-30 thousand IU.
- Umbilical lesions: primary dose - 10 thousand IU, and course - also 10 thousand IU.
The number of injections with antidiphtheria serum is prescribed depending on the clinical form of the pathology. For example, a single injection is given to patients who have localized or widespread forms 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 used again.
Serum is canceled after a significant improvement in the patient's condition (disappearance of edema of the cervical tissue,pharynx (its oral part), plaque and decrease intoxication).
Side effects
May be:
- immediate (appears immediately after applying the serum);
- early (4-6 days after drug use);
- remote (two or more weeks after injection).
The following side effects may occur: hyperthermia (fever), skin rash, chills, disturbances in the functioning of the cardiovascular system, convulsions, and so on. These phenomena do not last more than a few days. Rarely, collapse is possible. In the event of the occurrence of such adverse effects, it is necessary to prescribe timely adequate symptomatic therapy.
