Management of Tetanus

Introduction
Clostridium tetanineurotoxins
Forms durable spore in soil and animal feces and
remain viable for years.
Produce tetanospasminenter the CNS via
peripheral motor nerves or blood streambinds
to ganglioside membraneblocking release of
inhibitory transmittertonic spasm
superimposed intermittent tonic seizure.
Once bound toxins cannot be neutralized

Sign Symptoms
Jaw stiffnesstrismus
Restlessness, Iritability
Spasms
Risus sardonicus; rigid of abdominal, neck and back
muscles (opisthotonus); Sphincter spasmurinary
retention and constipation; Dysphagia

Painful intermittent generalized tonic spasm with

profuse sweating.
Respiratory failure: laryngeal spasm, rigidity of
abdominal wall, diaphragm and chest wall muscles.

Treatment
Supportive carequiet room, respiratory
support
Wound debridement
Tetanus antitoxinsHTIF 3000-6000 U, IM
Antibiotics:
Metronidazole 500mg/ q 6-8 h
Penicillin G 6 Mil Unit IV q 6 h
Doxycycline 100 mg PO q 12 h

 Benzodiazepins
Infants > 30 days: 1 to 2 mg IV given slowly,
repeated q 3 to 4 h as necessary
Young children: 0.1 to 0.8 mg/kg/day up to 0.1 to
0.3 mg/kg IV q 4 to 8 h
Children > 5 yr: 5 to 10 mg IV q 3 to 4 h
Adults: 5 to 10 mg po q 4 to 6 h or up to 40 mg/h
IV drip

 Autonomics Dysfunction
Mg sulfate at doses that maintain serum levels
between 4 to 8 mEq/L (eg, 4 g bolus followed by 2
to 3 g/h)
Morphine may be given q 4 to 6 h to control
autonomic dysfunction, especially cardiovascular;
total daily dose is 20 to 180 mg
Pyridoxine (100 mg once/day) lowers mortality in
neonates

Notes
Bantuan ventilator diberikan pada :
Semua penderita dengan tetanus derajat IV
Penderita dengan tetanus derajat III dimana
spasme tidak terkendali dengan terapi
konservatif dan PaO2 <>
Terjadi komplikasi yang serius seperti
atelektasis, pneumonia dan lain-lain.