This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The treatment of tetanus involves intensive care, muscle relaxant drugs and often assisted ventilation.

  • patient should be nursed in a dark, quiet room to reduce the risk of precipitating spasms
  • a low threshold to secure the airway must be maintained at all times and immediate intubation should be carried out in patients with respiratory distress (1)

Neutralization of unbound toxin

  • human antitetanus immunoglobulin is given intramuscularly (IM) to neutralise the free circulating toxins
  • 150units/kg of IM preparation may be given in multiple sites (IM preparations should not be given intravenously) (2)

Wound toilet

  • should also be carried out to reduce the bacterial and toxin load.

Antibiotic therapy

  • several antibiotics are useful against the tetanus bacterium
    • Metronidazole - is the antibiotic of choice and has superseded penicillin, is used for 7 days (1g PR three times daily)
    • the importance of penicillin in tetanus remains controversial : in a randomized, controlled trial mortality rate was higher in patients treated with penicillin when compared to metronidazole (24% vs 7%; P < 0.01)
  • acceptable alternatives include - erythromycin, tetracycline, chloramphenicol and clindamycin

Control of muscle rigidity and spasms

  • muscle spasms may be controlled effectively by sedation with
    • benzodiazepine - considered to be the first line treatment
      • diazepam (0.05-0.2mg/kg/h IV)
      • midazolam
    • opioids, such as morphine - can be equally efficacious and is usually used as an adjunct to benzodiazepine sedation
    • alternatively, phenobarbitone (1.0mg/kg/6h IM) or IV with chlorpromazine (0.5mg/kg/6h IM). The chlorpromazine is started 3h after the phenobarbitone
  • if all the above fails, then the patient is paralysed with tubocurarine 15mg IV and then ventilated.

Control of autonomic instability

  • circulatory collapse caused by autonomic instability is responsible for a majority of deaths in tetanus
  • sedation is the first line manoeuvre to control autonomic instability
  • other treatment methods used in autonomic instability include
    • magnesium sulphate - is useful in blocking catecholamine release from nerves and the adrenal medulla, and also reducing receptor responsiveness to released catecholamines. It is also a useful adjunct in the control of rigidity and spasms
    • atropine
    • clonidine
    • beta-blockade - although theoretically useful, sudden cardiovascular collapse, pulmonary oedema and death has been implicated

Supportive therapy

  • majority will require around 4-6 weeks of supportive therapy
  • nutritional support should be initiated early with enteral feeding since dysphagia, altered gastrointestinal function and increased metabolic rate will result in poor nutrition and weight loss
  • mouth care, chest physiotherapy and tracheal suction to prevent respiratory complication
  • sufficient sedation when invasive procedures are being carried out (to avoid provoking spasm or autonomic instability)
  • thromboembolism prophylaxis to prevent pulmonary embolism
  • psychological support (1)

Reference:


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.