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.
Highlights
Tetanus is caused by the obligatory anaerobic Grampositive bacillus Clostridium tetani
The traditional management strategy in tetanus involves sedation, neuromuscular paralysis and elective ventilation combined with wound debridement, antibiotic therapy and administration of human antitetanus immunoglobulin (HTIg) to neutralize the toxin
Due to the associated complications of prolonged ventilation, many have searched for ways of reducing the need for paralysis and elective ventilation
Summary
Tetanus is caused by the obligatory anaerobic Grampositive bacillus Clostridium tetani. Exhaustion, autonomic disturbances, and complications from muscle spasms (for example, asphyxiation, pneumonia, rhabdomyolysis, pulmonary emboli) can contribute to the high fatality rates observed in severe tetanus [10]. The most successful intervention against tetanus in history is its prevention by means of an effective vaccine; the success of vaccination has led to a dramatic fall in the incidence of tetanus [7]. Treatment of this disease is less effective, with high rates of mortality reported from case series around the world. This review addresses the timely need of summarizing the evidence base for currently used and experimental pharmacological therapy in treating tetanus
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