Table of Contents

Introduction
At risk patients
General prophylaxis for high risk patients
Rx of established tetanus

tetanus

see also:

Introduction

a now rare condition (thanks to widespread vaccination) caused by a neurotoxin from the anaerobic bacteria Clostridium tetani

At risk patients

those who have never been vaccinated or vaccination course incomplete or > 10 years ago who have a tetanus prone wound such as:
- retained foreign body esp. wood
- contaminated wound
- compound fracture
- extensive wound eg. burns
in particular:
- neonates as non vaccinated - high risk with cutting umbilical cord with non-sterile tools (eg. glass)
- elderly
- born overseas in countries where vaccination rates are low

General prophylaxis for high risk patients

tetanus immunoglobulin within 72hrs to cover immediate risk
tetanus vaccination in opposite limb to cover the period after immunoglobulin effect wanes and to prevent future episodes

Rx of established tetanus

supportive ICU care with intubation and Rx as below decreases mortality from 90% to around 10%
iv or PR metronidazole (PR has higher CNS concentrations as bypasses 1st pass effect)
- NB. penicillin is NO LONGER recommended as 1st line as it increases GABA release in CNS and increases muscle spasms
immunoglobulins decrease duration
anti-spasmodics
etc.