When should I consider referring a patient with suspected diphtheria to secondary care for further management?

Consider referring a patient with suspected diphtheria to secondary care immediately for further management if:

• There is clinical suspicion or confirmation of diphtheria, as it is a serious bacterial infection requiring specialist care.
• The patient shows signs of systemic toxicity, airway obstruction, or respiratory distress, which are common complications of diphtheria necessitating urgent hospital assessment and treatment.
• The patient requires administration of diphtheria antitoxin and intravenous antibiotics, which are typically managed in secondary care settings.
• There is uncertainty in diagnosis or the patient is at high risk of complications, warranting specialist infectious disease input and isolation facilities.

Early referral ensures access to appropriate antimicrobial therapy, antitoxin administration, airway management, and infection control measures to prevent transmission.