Pharmacological management of tetanus: an evidence-based review

Abstract

Tetanus is becoming rarer in both industrialized and developing nations due to an effective vaccination program. In 2010, the World Health Organization estimated there was a 93% reduction in newborns dying from tetanus worldwide, compared to the situation in the late 1980s. Due to its rarity, many diagnostic delays occur as physicians may not consider the diagnosis until the manifestations become overt. Without timely diagnosis and proper treatment, severe tetanus is fatal (mortality is also influenced by the comorbidities of the patient). The principles of treating tetanus are: reducing muscle spasms, rigidity and autonomic instability (with ventilatory support when necessary); neutralization of tetanus toxin with human antitetanus immunoglobulin or equine antitetanus sera; wound debridement; and administration of antibiotics to eradicate locally proliferating bacteria at the wound site. It is difficult to conduct trials on different treatment modalities in tetanus due to both logistical and ethical reasons. However, it is imperative that physicians are aware of the best evidence-based treatment strategies currently available to improve the outcome of patients. This review concentrates on analyzing the current evidence on the pharmacological management of tetanus.

Rocuronium for control of muscle spasms in a tetanus patient with chronic methamphetamine use disorder

“…Rocuronium was one of the newer non-depolarising neuromuscular blockers; hence, there are only two case reports, one on human and one on a dog, on the use of this neuromuscular junction blocker for tetanus. 7 Response to neuromuscular blockers is unpredictable in critically ill patients. The degree of blockade is ideally monitored with peripheral nerve stimulation using train-of-four (TOF) stimulation.…”

“…Benzodiazepines have been reported to have significant benefits, attributed to their combined anticonvulsant and muscle relaxation actions on tetanus muscle spasms and rigidity, together with their sedative and anxiolytic effects. 4 However, it has been cited that drug users are commonly difficult to sedate. Chronic methamphetamine use may cause tolerance to commonly used sedatives such as benzodiazepines.…”

Efficacy of concomitant use of dexmedetomidine and propofol in tetanus

“…Traditionally, benzodiazepines have been used to control muscle spasms due to its availability even in resource-limited settings. Despite lack of the evidence, diazepam and midazolam are commonly used intending to act as anticonvulsant as well as sedative [1]. Although neuromuscular blocking agents are considered in case of refractory convulsion, we should be aware that sustained benzodiazepines or neuromuscular blocking agents infusion may cause prolonged sedation, muscular relaxation, neuropathy, and myopathy [2,3].…”

“…Approximately 9600 tetanus cases were reported in 2010 globally according to the World Health Organization data [1], and the actual number of patients is estimated to be far more than that. Although its rarity in the developed world precludes randomized controlled trials, accumulation of clinical cases seems to be important to establish modern standard therapy for tetanus.…”

Правець: Огляд Сучасних Рекомендацій З Епідеміології, Етіології, Патогенезу, Клініки, Інтенсивної Терапії У Період Воєн І В Мирний Час

“…Далее мы приводим руководство Всемирной ор-ганизации здравоохранения (ВОЗ) по предупрежде-нию и лечению раневой инфекции (Tetanus: World Health Organization, 2012) [6,7,11,14].…”