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Tetanus: Treatment General Measures The goals of therapy are to eliminate the source of toxin, neutralize unbound toxin, and prevent muscle spasms while monitoring the patient's condition and providing support—especially respiratory support—until recovery. Patients should be admitted to a quiet room in an intensive care unit, where observation and cardiopulmonary monitoring can be maintained continuously but stimulation can be minimized. Protection of the airway is vital. Wounds should be explored, carefully cleansed, and thoroughly debrided. Antibiotic Therapy Although of unproven value, antibiotic therapy is administered to eradicate vegetative cells—the source of toxin. . | Chapter 133. Tetanus Part 4 Tetanus Treatment General Measures The goals of therapy are to eliminate the source of toxin neutralize unbound toxin and prevent muscle spasms while monitoring the patient s condition and providing support especially respiratory support until recovery. Patients should be admitted to a quiet room in an intensive care unit where observation and cardiopulmonary monitoring can be maintained continuously but stimulation can be minimized. Protection of the airway is vital. Wounds should be explored carefully cleansed and thoroughly debrided. Antibiotic Therapy Although of unproven value antibiotic therapy is administered to eradicate vegetative cells the source of toxin. The use of penicillin 10-12 million units IV given daily for 10 days has been recommended but metronidazole 500 mg every 6 h or 1 g every 12 h is preferred by some experts on the basis of this drug s excellent antimicrobial activity and the absence of the GABA-antagonistic activity seen with penicillin. The drug of choice remains unclear one nonrandomized clinical trial found a survival benefit with metronidazole but another study failed to find a difference among benzathine penicillin benzyl penicillin and metronidazole. Clindamycin and erythromycin are alternatives for the treatment of penicillin-allergic patients. Additional specific antimicrobial therapy should be given for active infection with other organisms. Antitoxin Given to neutralize circulating toxin and unbound toxin in the wound antitoxin effectively lowers mortality toxin already bound to neural tissue is unaffected. Human tetanus immune globulin TIG is the preparation of choice and should be given promptly. The dose is 3000-6000 units IM usually in divided doses because the volume is large. The optimal dose is not known however and results from one study indicated that a 500-unit dose was as effective as higher doses. Pooled IVIg may be an alternative to TIG but the specific antitoxin concentration in this .
