TETANUS

SUMMARY

• Tetanus is a clinical diagnosis and must be

considered in patients with muscle spasms and
an inadequate vaccination history.

• Supportive care is the mainstay of

management to avoid complications such as
nosocomial infection and thromboembolism.
• Since the disease is mediated by a toxin, one
aspect of therapy is to eliminate ongoing toxin
production, neutralize unbound toxin usually
with HTIG, and immunize against tetanus since
natural disease does not confer immunity.

• Antimicrobials play an adjunctive role in the

therapy of tetanus. Penicillin has been
traditionally used, but metronidazole is also
considered first-line therapy and in some
centers is the drug of choice.
• Muscular spasms are controlled with
sedation (usually benzodiazepines) or
neuromuscular blockade.

• Autonomic hyperactivity can be treated with

labetalol or morphine sulfate. Beta blockade
without concomitant alpha blockade should be
avoided. The use of magnesium sulfate for
both autonomic dysfunction and additional
control of muscle spasms has generated
considerable interest. This drug is readily
available and is used worldwide for the
treatment of eclampsia.

• Patients with shorter incubation periods

have increased disease severity and mortality.