Diphtheria, Pertussis, and Tetanus: An Update of Evidence-Based Management of Pediatric Patients in the Emergency Department (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: August 2025 (Volume 22, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 08/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits and 1 Pharmacology CME credit, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

Diphtheria, pertussis, and tetanus are potentially deadly illnesses that are largely preventable through vaccination, though they remain in the population. This review discusses the epidemiology, pathophysiology, diagnosis, and current recommended management of these conditions in the emergency department. Disease-specific medications and treatment of secondary complications are reviewed in light of the best current evidence. Issues regarding vaccination and prevention are highlighted.

Case Presentations

A local EMS crew rushes in a gurney with a toxic-appearing preschool-aged girl in obvious respiratory distress...

• The parents tell you the girl has had recent congestion and a low-grade fever.
• In the ED, the child has a fever of 38ºC, a heart rate of 150 beats/min, a blood pressure of 75/45 mm Hg, and a respiratory rate of 35 breaths/min. On examination, there is inspiratory stridor, significant cervical lymphadenopathy, and a thick, grayish membrane coating the posterior pharynx. Chest examination reveals bilateral rales and tachycardia with frequent ectopic beats.
• Could this child have viral myocarditis associated with simple pharyngitis? You page the infectious disease specialist and ask the nurse to institute strict isolation precautions. What tests, if any, should you order to confirm your suspected diagnosis?

A panicked mother rushes into the emergency department, screaming that her 3-week-old boy is not breathing...

• In the resuscitation bay, the monitor shows a respiratory rate of 30 breaths/min, a heart rate of 140 beats/min, and oxygen saturation of 98% on room air. The physical examination is unremarkable apart from occasional gagging. You note that the baby’s school-aged sibling begins coughing.
• What infectious etiology could explain these children’s very different presentations?

A 5-year-old boy is brought in by his parents for a wound on his foot…

• The boy is holding a bandage to his foot. His parents report that he stepped on a nail while playing at a farm earlier that day.
• On examination, you note a small puncture wound that does not appear grossly soiled and is not actively bleeding. While taking the history, you learn the child is unimmunized and at risk for tetanus.
• It seems unlikely that you alone can change the parents’ minds about vaccines. Should you attempt to discuss the topic with the family? Should you call the primary care doctor and see if he or she can convince them? Could an antibiotic prevent tetanus from developing?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.