13.3 Tetanus
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Tetanus | 500 international unit (IU) single dose of HTIG (human tetanus immune globulin) PLUS Metronidazole 500 mg IV q6h for 7 to 10 days. Or Penicillin G 2-4 million units q4h for 7 to 10 days | Doxycycline 100mg q12h for 7-10 days | Treatment includes tetanus immunoglobulin, antibiotic therapy, neuromuscular blockade, and supportive care for respiratory complications, autonomic instability, and muscle spasms. Antispasmodics such as benzodiazepines, baclofen, vecuronium, pancuronium and propofol have been used based on the clinical scenario. MgSO4 should be used in case of autonomic instability. Clinical condition should be assessed by Ablett score. |
For common etiological agents of Tetanus, see Annexure B.13.3
References
1. Guidance on the management of suspected tetanus cases and the assessment and management of tetanus-prone wounds. UK Health Security Agency. 2024. Available from: https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds
2. Rodrigo C, Fernando D, Rajapakse S. Pharmacological management of tetanus: an evidence- based review. Crit Care. 2014 Mar 26;18(2):217. doi: 10.1186/cc13797. PMID: 25029486; PMCID: PMC4057067.