Management guideline for tetanus patients in JRRH
Childrens’ unit
Tetanus is caused by Clostridium tetani, a gram positive anaerobic bacteria
found in soil and human and animal intestines
It causes muscle spasm by toxin release
Generalised tetanus is the commonest clinical presentation
It can be fatal
Basic management
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Nurse in quiet, darkened room
Minimal handling
Clean wounds and remove necrotic tissue
Insert IV cannula and nasogastric tube
Tetanus causes high energy requirements – ensure patient is fed 2 hourly
via NGT, neonates should be fed 1 hourly
Specific treatment
Neutralise toxin
Give tetanus immunoglobulin or anti-tetanus serum as soon as possible
Drug
Tetanus immunoglobulin
Anti-tetanus serum
Dose
500 iu in two separate sites (250 iu
per site) intramuscularly
1500 units intramuscularly
Inhibition of toxin production
Give metronidazole 7.5 mg/kg IV 8 hourly for 10 days
Neonates require a loading dose of 15 mg/kg IV followed by 7.5 mg/kg IV 12
hourly for 10 days
Sedation
Survival depends on minimising spasms – it is important that patients receive
regular, adequate sedation which should be given IV or via the NGT.
Avoid giving im injections.
Diazepam 0.3 mg/kg 4-6 hourly
Chlorpromazine 0.5 mg/kg 6 hourly
Analgesia
Tetanus spasms are painful and can be severe enough to cause fractures
Prescribe adequate analgesia
 Paracetamol 15 mg/kg 8 hourly
 Diclofenac 0.5 mg/kg 12 hourly
In severe pain consider morphine:
 Morphine 0.2 mg/kg 6 hourly –monitor closely for respiratory depression
Monitor for signs of superimposed infections especially pneumonia and
treat.
On discharge
Patients who have been managed for tetanus do not develop immunity
Tetanus toxoid vaccination should be given on discharge and further doses given
1 month and 2 months after the initial dose.
Mothers of neonates with tetanus should also be given tetanus toxoid.