Treatment
Mild tetanus
Mild cases of tetanus can be treated with:[22]

tetanus immunoglobulin, also called tetanus antibodies or tetanus antitoxin[20] It can be given as
intravenous therapy or by intramuscular injection.

metronidazole IV for 10 days

diazepam oral or IV
Severe tetanus
Severe cases will require admission to intensive care. In addition to the measures listed above for mild
tetanus:[22]

Human tetanus immunoglobulin injected intrathecally (increases clinical improvement from 4%
to 35%)

Tracheotomy and mechanical ventilation for 3 to 4 weeks. Tracheotomy is recommended for
securing the airway, because the presence of an endotracheal tube is a stimulus for spasm

Magnesium, as an intravenous (IV) infusion, to prevent muscle spasm

Diazepam as a continuous IV infusion

The autonomic effects of tetanus can be difficult to manage (alternating hyper- and hypotension
hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, or nifedipine
Drugs such as diazepam or other muscle relaxants can be given to control the muscle spasms. In
extreme cases it may be necessary to paralyze the patient with curare-like drugs and use a mechanical
ventilator.
In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required.
An intake of 3,500 to 4,000 calories, and at least 150 g of protein per day, is often given in liquid form
through a tube directly into the stomach (percutaneous endoscopic gastrostomy), or through a drip into
a vein (parenteral nutrition). This high-caloric diet maintenance is required because of the increased
metabolic strain brought on by the increased muscle activity. Full recovery takes 4 to 6 weeks because
the body must regenerate destroyed nerve axon ter
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Treating tetanus
It is important that tetanus is treated quickly to prevent complications from developing.
There are two types of treatment for tetanus:

preventative treatment - for people who are thought to be fully or partially vaccinated against
tetanus and who have an injury that makes them vulnerable to a tetanus infection

symptomatic treatment - for people who have developed the symptoms of an active tetanus
infection

Preventative treatment
Wounds that are vulnerable to a tetanus infection are called tetanus-prone wounds.
Tetanus-prone wounds
Tetanus-prone wounds include:

wounds or burns that required surgery to repair, but access to surgery was delayed for six hours
or more

wounds or burns that cause a significant amount of tissue loss

puncture injuries, particularly if they may have become contaminated with soil or manure

wounds that contain foreign bodies, such as an animal’s tooth

severe bone fractures that may have left the bones vulnerable to infection

wounds and burns in patients who have systemic sepsis (a fall in blood pressure as a result of a
serious bacterial infection)
Medication called tetanus immunoglobulin (TIG) is recommended if you have a tetanus-prone wound
and there is a high risk that it could be contaminated by tetanus bacteria. This might be the case if the
wound came into contact with soil or animal waste.
The use of TIG is recommended even if your vaccinations are up to date. There may be a very small
chance that the vaccine did not give you total immunity against tetanus.
Tetanus immunoglobulin
Tetanus immunoglobulin (TIG) is a medication that contains antibodies that kill the tetanus bacteria.
Antibodies are infection-fighting proteins. Tetanus immunoglobulin is given as an injection into a muscle
and gives immediate, short-term protection against tetanus. It is thought to be safe to use in pregnant
and breastfeeding women.
After having tetanus immunoglobulin, you are likely to have some short-term discomfort at the site of
the injection. Other side effects are thought to be uncommon but may include:

chest pain

shortness of breath

dizziness

swelling of your face

mouth ulcers

shaking

joint pains
Speak to the doctor in charge of your care if you develop any of these side effects.
Depending on whether your vaccinations are up to date, you may also be given a booster dose of the
tetanus vaccine.
Treating tetanus symptoms
f someone develops the symptoms of tetanus, they will need to be admitted to hospital.
Because tetanus is rare in the UK, an infected person may be transferred to one of the larger NHS
hospitals, where doctors with experience in treating tetanus are usually based.
The three main types of medication used to treat the symptoms of tetanus are:

sedatives

muscle relaxants

neuromuscular blocking agents (NBAs)
Sedatives
Sedatives are a type of medication that make you feel physically and mentally relaxed. They relax the
muscles, which can help relieve and prevent muscle stiffness.
Side effects of sedatives include:

drowsiness

irritability

depression

shaky movements and an unsteady walk (ataxia)

hyperactivity

seeing or hearing things that are not real (hallucinations)
Muscle relaxants
Muscle relaxants are a type of medication that help relax the muscles. They are often used when
treatment with sedatives is withdrawn (sedatives can be addictive so they are not usually recommended
as a long-term treatment).
You will be given muscle relaxants to stop your symptoms returning when your dose of sedatives are
reduced.
Neuromuscular blocking agents (NBAs)
Neuromuscular blocking agents (NBAs) are a type of medication that block nerve signals sent from the
brain to the muscles. This leads to an inability to move certain muscles (paralysis), which can be useful in
people with severe muscle spasms and stiffness.
A neuromuscular blocking agent called vecuronium is usually prescribed. Vecuronium causes paralysis of
the muscles used for breathing, so assistance with breathing is provided before it can be given.
Preventing further spread of neurotoxins
Tetanus immunoglobulin can be used to prevent the tetanospasmin neurotoxin causing further damage
and disruption to your nervous system. Antibiotics such as penicillin (or metronidazole if you are allergic
to penicillin) are also used to try to kill any bacteria and prevent any further toxins being released.
Surgery
If a tetanus-prone wound is particularly large, it may be necessary to remove as much of the damaged
and contaminated muscle as possible using a surgical procedure called debridement.
Debridement involves cleaning an open wound by removing foreign material, such as dirt and manure,
as well as any dead tissue. In the case of a tetanus infection, debridement will remove any remaining
tetanus bacteria.
Nutrition and breathing
The increased muscle activity caused by tetanus means that a person with the infection needs to
consume a high amount of calories. An intake of 3,500 to 4,000 calories a day is often required, plus
150g of protein a day.
If swallowing is difficult or not possible, it may be necessary to give a liquid feed through a tube
connected to the stomach or through a drip into a vein. Help with breathing may also be required using
a ventilator (a machine that helps you breathe