Alif Mutahhar, Dwiyanti Puspitasari

Abstract views = 1029 times | downloads = 994 times


Diphtheria is an acute infection disease caused by Corynebacterium diphtheriae. It remains a problem in Indonesia in a recent several years especially in East Java Province, which suffered from an outbreak of diphtheria in 2011. Erythromycin is the second line antibiotics therapy for diphteria if the patient is allergic to penicillin, also serving as a prophylactic and carrier therapy for contact diphtheria. Erythromycin has been used for diphtheria for a very long time, but there is little recent data on its sensitivity  against C. diphtheriae. The purpose of this study is to identify whether Erythromycin still has a strong antibacterial activity against Corynebacterium diphtheriae by invitro test. This was a descriptive study which observed the sensitivity pattern of erythromycin against Corynebacterium diphtheriae using the Epsilometer test (etest) as a diffusion technique. Samples used in this study were 30 isolates of toxigenic Corynebacterium diphtheriae strain mitis and gravis at the Center for Health Laboratory (BBLK) Surabaya obtained during 2011 until 2014. We retrieved the data based on gender, age, and districts of patients for each of the samples then analyzed them descriptively. In this study, a sensitivity test of 30 toxigenic Corynebacterium diphtheriae isolates revealed that 27 (90%) were sensitive to Erythromycin (average Minimum Inhibitory Concentration/ MIC) <0.016 μg/mL and all were strain mitis, while 3 (10%) had intermediate sensitivity with MIC 1 μg/mL (all were strain gravis). No resistance result was found from the sensitivity test. According to the result, we conclude that Erythromycin still has a strong antibacterial activity against Corynebacterium diphtheriae.


C. diphtheriae, Erythromycin, Sensitivity, Epsilometer test

Full Text:



Central Disease Control. Diphtheria [monograph online]. Atlanta, US Department of Health and Human Services; 2013. [cited 2013 June 22]. Available from : CDC.

Vyas JM, Zieve David, Black B, Slon S, Wang N. Diptheria Symptoms and Treatment [monograph online]. ADAM Healths Solutions; 2013. [cited 2013 May 17]. Available from : PubMed.

Murphy JR. Corynebacterium diphtheriae. Galveston: University of Texas Medical Branch; 1996. Medical Microbiology 4th edition, Chapter 32.

Holmes RK. Biology and Molecular Epidemiology of Diphtheria Toxin and The Tox Gene. The Journal of Infectious Diseases. 2000 Feb;181 Suppl 1:S156-67

Health Protection Agency. Identification of Corynebacterium spp. [monograph online] UK Standards for Microbiology Investigations; 2011. [cited 2013 June 23]. Available from : HPA.

World Health Organization. Diphtheria Reported Case [monograph online]. Geneva, WHO Vaccine-Preventable Diseases Monitoring Global Summary; 2014. [cited 2015 Jan 8]. Available from: WHO.

Health Office of East Java Province. Kegiatan Sub PIN Difteri Sebagai Bagian Penanggulangan KLB Difteri di Jawa Timur [monograph online]. Surabaya, Health Office of East Java Province Site; 2012. [cited 2015 Jan 8]. Available from : Health Office of East Java Province.

Kneen R, Pham NG, Solomon T, Tran TM, Nguyen TT, Tran BL, et al. Penicillin vs. Erythromycin in the Treatment of Diphtheria. Clinical Infectious Diseases. 1998 Oct;27(4):845-50.

Gaynor M, Mankin AS. Macrolide Antibiotics: Binding Site, Mechanism of Action, Resistance. Current Topics in Medicinal Chemistry. 2003;3(9):949-61.

Miller LW, Bickham S, Jones WL, Heather CD, Morris RH. Diptheria Carriers and the Effect of Erythromycin Therapy. Antimicrobial Agents and Chemotherapy. 1974 Aug;6(2):166-9.

Kucers A, Bennett NM. The Use of Antibiotics a Comprehensive Review with Clinical Emphasis. Butterworth-Heinemann Ltd. 1987;4th edition: 851-67.

Katzung BG, Masters SB,Trevor AJ. Basic and Clnical Pharmacology. San Fransisco :McGraw Hill Professional; 2009. 11th edition: 1024-25.

Engler KH, Glushkevich T, Mazurova IK, George RC, Efstratiou A. A Modified Elek Test for Detection of Toxigenic Corynebacteria in The Diagnostic Laboratory. Journal of Clinical Microbiology. 1997 Feb;35(2):495-8.

Citron DM, Ostovari MI, Karlsson A, Goldstein EJ. Evaluation of the E Test for Susceptibility Testing of Anaerobic Bacteria. Journal of Clinical Microbiology. 1991 Oct;29(10):2197-2203.

Clinical and Laboratory Standards Institute. Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria; Proposed Guideline. US: M45-P; 2007. Vol 25(26).

Volzke H, Kloker KM, Kramer A, Guertier L, Doren M, Baumeister SE, et al. Susceptibility to Diphtheria in Adults: Prevalence and Relationship to Gender and Social Variables. Clinical Microbiology and Infection. 2006 Oct;12(10):961-7.

Gordon RC, Yow MD, Clark DJ, Stephenson WB. In Vitro Susceptibility of Corynebacterium diphtheriae to Thirteen Antibiotics. Applied Microbiology. 1971 Mar;21(3):548-549.

McLaughlin JV, Bickham ST, Wiggins GL, Larsen SA, Balows A, Jones WL. Antibiotic Susceptibility Patterns of Recent Isolates of Corynebacterium diphtheriae. Applied Microbiology. 1971 May;21(5):844-851.

Rockhill RC, Sumarmo, Hadiputranto H, Siregar SP, Muslihun B. Tetracycline Resistance of Corynebacterium diphtheriae Isolated from Diphtheria Patients in Jakarta, Indonesia. Antimicrobial Agents and Chemotherapy. 1982 May;21(5):842-3.

Engler KH, Warner M, George RC. In Vitro Activity of Ketolides HMR 3004 and HMR 3647 and Seven Other Antimicrobial Agents Against Corynebacterium diptheriae. The Journal of Antimicrobial Chemotherapy. 2001 Jan;47(1):27-31.


  • There are currently no refbacks.

Copyright (c) 2020 Indonesian Journal of Tropical and Infectious Disease

View My Stats

IJTID Indexed by : 


IJTID (pISSN 2085-1103eISSN 2356-0991is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Lembaga Penyakit Tropis (Institute of Tropical Disease)

Universitas Airlangga

Kampus C Mulyorejo

Surabaya 60115