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It is an acute, often fatal disease caused by an exotoxin produced by the anaerobic bacterium Clostridium tetani. It is acquired through wounds contaminated with spores of the bacteria and in the case of neonates, through the umbilical stump, resulting in neonatal tetanus

Diagnostic criteria

  • Generalized spasms and rigidity of skeletal muscles

  • Locked jaws

  • Patients are usually fully conscious and aware.

  • Dysphagia

  • diaphoresis

  • Local spasms may also occur 

Supportive Therapy 

  • Nurse in dark, quiet room to avoid unnecessary external stimuli which can trigger spasms

  • Protect the airway

  • Thorough cleaning of the site of entry (wound/umbilicus), leaving it exposed without dressing

  • Pain management with Paracetamol (via NGT) as the spasms can be very painful

  • Maintenance of fluid balance and nutrition (via NGT)

  • Avoid giving medications via IV/IM route as injections can trigger spasms

  • Sedation (see below) and care as for unconscious patient 


Pharmacological Treatment

Treatment is generally aimed at the following:

For prevention of further absorption of toxin from the wound  


  • Human tetanus immunoglobulin; Adults give 3000IU stat   


  • Amoxicillin 500mg via NGT 8 hourly for 5 days  


  • Metronidazole 400mg 8 hourly for 5 days   


Control of spasms

Give a sedative cocktail of ALL the following via NGT:  

  • Injection Diazepam10–30 mg 4–6 hourly      

Children: 0.5 mg/kg 6 hourly   


  • Injection Chlorpromazine100–200 mg 8 hourly       

Children 2 mg/kg 6 hourly  



  • Injection Phenobarbitone 50–100 mg 12 hourly      

Children 6 mg/kg 12 hourly 

Guidelines for dosage administration**​​

Tetanus dosage administration-ulyclinic


Tetanus (toxoid) vaccine 0.5 ml IM; repeat after 4 weeks and after 6-12 months, then boost every 10 years thereafter

Updated on, 31.10.2020


1. STG 

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