Treatment of Clostridium tetani infections

Treatment

Treatment of tetanus is (a) initial supportive therapy, (b) wound debridement and care, (c) stopping toxin production, (d) neutralizing unbound toxin, (e) controlling disease manifes-tations, and (f) managing complications. It includes antibiotics therapy and human immunoglobulin therapy.

◗ Antibiotics therapy

Antibiotics are used to prevent multiplication of C. tetani in the wound, thus halting the production and release of toxins. Metronidazole is the current antimicrobial drug of choice with penicillin as an alternative treatment. Tetracycline is an alterna-tive drug for patients who are allergic to penicillin or metro-nidazole. Clindamycin, erythromycin, and vancomycin are the other antimicrobials used in the treatment of tetanus.

◗ Human immunoglobulin therapy

Human tetanus immunoglobulin (TIG) is given to neutral-izes unbound tetanus toxins, and also to prevent circulating tetanus toxin from reaching the CNS. A single total dose of 3000–6000 IU is given intramuscularly for children and adults immediately at the time of diagnosis. A lower dose of 500 IU for infants with tetanus neonatorum has been effective.

In countries where TIG is not available, equine tetanus antitoxin (ATS) is used for the purpose. Tetanus antitoxin is administered intramuscularly as a single dose of 50,000– 100,000 IU after appropriate testing for sensitivity and desen-sitization, if necessary. Part of this dose (20,000 IU) is always given intravenously.