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Drugs used to treat muscle spasm, rigidity, and tetanic seizures include sedative-hypnotic agents, general anesthetics, centrally acting muscle relaxants, and neuromuscular blocking agents. Antibiotics are used to prevent multiplication of C tetani, thus halting production and release of toxins. 

  1. Medical Care:
    Passive immunization with human tetanus immune globulin (TIG) shortens the course and may lessen its severity. A dose of 500 U appears effective.
    1. Supportive therapy include ventilatory support and pharmacologic agents that treat reflex muscle spasms, rigidity, and tetanic seizures.
    2. Benzodiazepines have emerged as the mainstay of symptomatic therapy for tetanus. To prevent spasms that last longer than 5-10 seconds, administer diazepam intravenously, typically 10-40 mg every 1-8 hours.
    3. Vecuronium (by continuous infusion) or pancuronium (by intermittent injection) are adequate alternatives.
    4. Penicillin G, which has been used widely for years, has been the drug of choice. Metronidazole (eg, 0.5 g q6h) has comparable or better antimicrobial activity.
    5. Other drugs used are sedative hypnotics, narcotics, inhalational anesthetics, neuromuscular blocking agents, and centrally acting muscle relaxants (eg, intrathecal baclofen). 
  2. Complications:
    1. Sudden cardiac death has been attributed to excessive catecholamine productions, direct action of tetanospasmin, or tetanolysin on the myocardium.
    2. Further complications include the following:
      1. Long bone fractures
      2. Glenohumeral joint and temporomandibular joint dislocations
      3. Hypoxic injury, aspiration pneumonia, and pulmonary emboli
      4. Adverse effects of autonomic instability, including hypertension and cardiac dysrhythmiasQ
      5. Paralytic ileus, pressure sores, and urinary retention
      6. Malnutrition and stress ulcers
      7. Coma, nerve palsies, neuropathies, psychological aftereffects, and flexion contractures 
  3. Prognosis:
    1. The prognosis is dependent on incubation period, time from spore inoculation to first symptom, and time from first symptom to first tetanic spasm.
    2. In general, shorter intervals indicate more severe tetanus and a poorer prognosis.

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