Tetanus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The wound must be cleaned. Dead and infected tissue should be removed by surgical debridement. Metronidazole treatment decreases the number of bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus, but is no longer the treatment of choice because of a theoretical risk of increased spasms. It should still be used if metronidazole is not available. Passive immunization with human anti-tetanospasmin immunoglobulin or tetanus immune globulin is crucial. If specific anti-tetanospasmin immunoglobulin is not available, then normal human immunoglobulin may be given instead. All tetanus victims should be vaccinated against the disease or offered a booster shot. It takes 2-14 days for symptoms to develop after infection. Symptoms peak 17 days after infection.
Mild tetanus
Mild cases of tetanus can be treated with:
Severe tetanus
Severe cases will require admission to intensive care. In addition to the measures listed above for mild tetanus:
- human tetanus immunoglobulin injected intrathecally (increases clinical improvement from 4% to 35%)
- tracheostomy and mechanical ventilation for 3 to 4 weeks,
- magnesium, as an intravenous (IV) infusion, to prevent muscle spasm,
- diazepam (known under the common name Valium) as a continuous IV infusion,
- the autonomic effects of tetanus can be difficult to manage (alternating hyper- and hypotension, hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, or nifedipine.
Drugs such as chlorpromazine or diazepam, or other muscle relaxants can be given to control the muscle spasms. In extreme cases it may be necessary to chemically paralyze the patient with curare-like drugs and use a mechanical ventilator.
In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3500-4000 Calories, and at least 150g of protein, is often given in liquid form through a tube directly into the stomach, or through a drip into a vein. This high-caloric diet maintenance is required due to the increased metabolic strain brought on by the increased muscle activity.
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