Pharmacotherapy of tetanus--a review.
With adequate immunization, tetanus caused by the gram-positive anaerobic cocci, clostridium tetani, is a preventable disease. In treating C. tetani infection, Metronidazole as an antibiotic is more effective than Penicillin G since it is a GABA antagonist. Agents used to control spasm and rigidity should have little effect on the level of consciousness, respiration and blood pressure. The drug of choice for treating spasm and rigidity is benzodiazepine, a GABA agonists. Large doses of benzodiazepines may be required to overcome the spasm and are safe. Baclofen is another GABA agonist, which has been tried as an alternative to benzodiazepine with moderate success. Clinical experience with dantrolene sodium is limited. Magnesium with its unique properties on the neuromuscular junction and sympathetic system has been used to treat both spasms and autonomic dysfunction with limited success. Neuromuscular blocking drugs are indicated depending on the severity of spasms. Neuromuscular blocking drugs with steroid molecule should be avoided in view of prolonged weakness. No drug has consistently proven to be effective in the treatment of autonomic dysfunction. Beta-blockers, variation of and beta blockers, opioids, clonidine, magnesium, spinal and epidural anaesthesia have been tried with varying success. Beta-blockers should be used with caution as they have been implicated in the deaths of some patients with autonomic dysfunction.
Reddy
Venu Gopal
VG
Department of Anaesthesia & ICU, College of Medicine, Sultan Qaboos University, P.O. Box: 35, PC: 123-SQU, Muscat, Sultanate of Oman. gowri@omantel.net.om
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000992:Antitoxins / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D013742:Tetanus / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D000992:Antitoxins; D009466:Neuromuscular Blocking Agents