Intravenous magnesium sulphate infusion as first-line therapy in the control of spasms and muscular rigidity in childhood tetanus

Shanbag, Preeti; Mauskar, Anupama; Masavkar, Sanjeevani

doi:10.1080/20469047.2018.1542884

Cited by 7 publications

(14 citation statements)

References 19 publications

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“…Several other studies demonstrated spasm control in magnesium therapy alone. Of note, Mathew et al demonstrated control of spasms in 6 of 33 patients with Grades I and II Ablett classifications using magnesium alone, and Shanbag et al showed that 14 of 27 children with Ablett grades II and III tetanus experienced spasm control with magnesium alone [15,16]. Attygalle et al (2002) found that magnesium therapy alone was sufficient for control of spasms in 38 of their 40 patients when maintained at a serum magnesium level of 2–4 mmol/l[13].…”

Section: Resultsmentioning

confidence: 99%

“…The severity of tetanus was assessed by Ablett's grading in all included studies [21] [9,15,16,18,19]. The severity of tetanus in the control group was similar to that of the magnesium group in all studies that had a control group.…”

Section: Baseline Severity Of Study Participantsmentioning

confidence: 99%

“…Most of the included studies used a 4-5 g (or 75-80 mg/ kg) IV loading dose of magnesium followed by an infusion dose of 2-3 g per hour until muscle spasm control was achieved. However, Thwaites et al and Shanbag et al used a loading dose of 40 and 100 mg/kg, respectively [8,16]. In the study by Pokharel et al, the infusion was initiated without a loading dose [18].…”

Section: Drugs and Dosesmentioning

confidence: 99%

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Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review

Nepal

Coghlan

Yadav

et al. 2021

Tropical Med Int Health

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Tetanus is a rare life-threatening condition often complicated by repetitive spasms, dysautonomia and neuromuscular respiratory failure contributing to high fatality rates in its severe form. Benzodiazepines used to treat muscle spasms pose a high risk of respiratory failure requiring mechanical ventilation, which is unaffordable and inaccessible for many. Magnesium sulfate, a cheap and widely available medication in all urban and rural health centres of LMICs for the treatment of eclampsia, can be used to control muscle spasms and dysautonomia. We thus conducted a systematic review of evidence to assess the safety and efficacy of magnesium sulfate in the treatment of tetanus. Any study published before April 15, 2021, discussing the efficacy and/or safety of MgSO4 infusion in the treatment of tetanus was systemically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our systematic review included data from 13 studies, three were randomised, double-blind and controlled trials.The remaining ten studies were observational; six prospective and four retrospective studies. Our review showed no mortality benefit associated with the use of magnesium sulfate. However, magnesium sulfate was found to be effective in reducing spasms along with diazepam, leading to better control of dysautonomia, reduced need for mechanical ventilation and shorter hospital stay by 3-7 days. The incidence of magnesium toxicity was very low in the studies included.

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Section: Resultsmentioning

confidence: 99%

Section: Baseline Severity Of Study Participantsmentioning

confidence: 99%

Section: Drugs and Dosesmentioning

confidence: 99%

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Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review

Nepal

Coghlan

Yadav

et al. 2021

Tropical Med Int Health

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“…This drug adjusts cardiac instability without compromising 24) . Only magnesium sulfate has been evaluated in a randomized clinical trial of severe tetanus 25) , and in several series for managing spasm including NT [26][27][28][29] . Thus, magnesium sulfate is given as a first-line agent in the management of NT.…”

Section: ) Management Of Autonomic Dysfunctionmentioning

confidence: 99%

Neonatal tetanus

Brook

2021

Pediatr Emerg Med J

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Neonatal tetanus, also known as tetanus neonatorum, occurs in young infants of inadequately immunized mothers. It is a kind of generalized tetanus that is exhibited mainly by prevention of the release of the inhibitory neurotransmitters (i.e., disinhibition) and is initiated by tetanospasmin, an exotoxin created by Clostridium tetani. Contamination of the umbilical cord stump is the main cause. The typical, early manifestations are weakness and lack of ability to suck, continuing within hours to trismus, risus sardonicus, and ultimately generalized tetanic spasm, rigidity, and opisthotonus. Without treatment, neonatal tetanus has a poor outcome with a mortality rate above 90%. Mortality can result from asphyxia due to the spasm and hypersympathetic state. The managing goals are to neutralize its toxin, eradicate C. tetani, care for wound, and offer supportive care, such as mechanical ventilation, parenteral nutrition, sedation, neuromuscular blockade, and management of autonomic dysfunction.

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“…Os sedativos utilizados variam de benzodiazepínicos, como midazolam e diazepam, a agentes anestésicos como o propofol e são terapias padrão para o controle de espasmos musculares e convulsões provocadas pela doença150 . O sulfato de magnésio (MgSO4) também é utilizado como terapia no controle dos espasmos e rigidez muscular, mas não é eficaz quando o tétano progride para uma forma mais severa151 .…”

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Caracterização e avaliação da atividade enzimática da toxina tetânica submetida à radiação gama por Cobalto 60

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Intravenous magnesium sulphate infusion as first-line therapy in the control of spasms and muscular rigidity in childhood tetanus

Cited by 7 publications

References 19 publications

Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review

Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review

Neonatal tetanus

Caracterização e avaliação da atividade enzimática da toxina tetânica submetida à radiação gama por Cobalto 60

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