From the Guidelines
Tetanus infection treatment options are primarily focused on wound care, vaccination, and immunoglobulin administration.
Treatment Options
- Wound care: Appropriate wound care and debridement are critical to tetanus prevention 1.
- Vaccination: Age-appropriate vaccines should be used if possible, with Tdap (or Td if Tdap is unavailable) recommended for adult patients who cannot confirm receipt of a tetanus booster in the preceding 5 years 1.
- Immunoglobulin administration: Tetanus Immune Globulin (TIG) may be indicated if completion of a primary vaccination series is uncertain, with a recommended prophylactic dose of 250 units IM for adult and pediatric patients 1.
Special Considerations
- Mass-casualty setting: In a mass-casualty situation, unusually high demand might result in shortages of age-specific vaccine formulations, and logistic considerations might make differentiating patients by age category prohibitive 1.
- TIG shortage: If TIG is in short supply, use of TIG should be reserved first for persons aged >60 years and for immigrants from regions other than North America or Europe 1.
- Concurrent administration: When tetanus toxoid and TIG are administered concurrently, separate syringes and separate sites should be used 1.
From the Research
Treatment Options for Tetanus Infection
The treatment of tetanus infection involves several strategies, including:
- Reducing muscle spasms, rigidity, and autonomic instability 2, 3
- Neutralization of tetanus toxin with human antitetanus immunoglobulin or equine antitetanus sera 3, 4
- Wound debridement to remove the source of the infection 3, 4
- Administration of antibiotics to eradicate locally proliferating bacteria at the wound site 3, 4
- Control of spasm and rigidity using benzodiazepines, a GABA agonist, as the drug of choice 2
- Use of other GABA agonists, such as baclofen, as an alternative to benzodiazepines 2
- Management of dysautonomia using beta-blockers, opioids, clonidine, magnesium, spinal, and epidural anesthesia 2, 3
Pharmacological Management
The pharmacological management of tetanus involves the use of various medications, including:
- Metronidazole as an antibiotic, which is more effective than Penicillin G 2
- Benzodiazepines to control spasm and rigidity 2
- Baclofen as an alternative to benzodiazepines 2
- Magnesium to treat both spasms and autonomic dysfunction 2
- Neuromuscular blocking drugs to manage severe spasms 2
- Beta-blockers to manage autonomic dysfunction, although they should be used with caution 2, 3
Supportive Care
Supportive care is also an essential part of the management of tetanus, including: