Clinical Management of Diphtheria

Publication Date: February 2, 2024
Last Updated: February 13, 2024

Summary of Recommendations

In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) in preference to penicillin antibiotics. (S, L )
  • Antibiotics should be administered alongside DAT and should not be delayed.
  • Recent evidence suggests that there is increasing resistance to penicillins and less resistance to macrolide antibiotics. Local antimicrobial susceptibility testing is vital to ensure the ongoing appropriate use of antibiotics.
  • The choice of macrolide will depend on availability and feasibility.

In patients with suspected or confirmed diphtheria, WHO recommends not to perform routine sensitivity testing prior to administration of diphtheria antitoxin. (S, M )
  • Due to the risk of allergic reaction, ensure sufficient trained staff and equipment are available and the patient is cared for in an area where they can be monitored closely.

In patients with suspected or confirmed symptomatic diphtheria, WHO suggests administration of a single dose of diphtheria antitoxin with choice of dose based on disease severity and time since symptom onset, in comparison with a fixed dose for all patients. (C, VL )

Recommendation Grading


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Clinical Management of Diphtheria

Authoring Organization

Publication Month/Year

February 2, 2024

Last Updated Month/Year

February 19, 2024

Document Type


Country of Publication


Document Objectives

The WHO Clinical management of diphtheria contains the most up-to-date recommendations for the clinical management of people with diphtheria. 

Target Provider Population

Clinicians treating patients with diphtheria.

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D004165 - Diphtheria



Source Citation

Clinical management of diphtheria: guideline, 2 February 2024. Geneva: World Health Organization; 2024 (WHO/DIPH/Clinical/2024.1). Licence: CC BY-NC-SA 3.0 IGO