see also:

• RCH guideline - tetanus prophylaxis
• RCH guideline - tetanus-prone wounds
• clinically important bacteria
• gas gangrene / Clostridial myonecrosis

• a now rare condition (thanks to widespread vaccination) caused by a neurotoxin from the anaerobic bacteria Clostridium tetani

• those who have never been vaccinated or vaccination course incomplete or > 10 years ago who have a tetanus prone wound such as:
  • retained foreign body esp. wood
  • contaminated wound
  • compound fracture
  • extensive wound eg. burns
• in particular:
  • neonates as non vaccinated - high risk with cutting umbilical cord with non-sterile tools (eg. glass)
  • elderly
  • born overseas in countries where vaccination rates are low

• tetanus immunoglobulin within 72hrs to cover immediate risk
• tetanus vaccination in opposite limb to cover the period after immunoglobulin effect wanes and to prevent future episodes

• supportive ICU care with intubation and Rx as below decreases mortality from 90% to around 10%
• iv or PR metronidazole (PR has higher CNS concentrations as bypasses 1st pass effect)
  • NB. penicillin is NO LONGER recommended as 1st line as it increases GABA release in CNS and increases muscle spasms
• immunoglobulins decrease duration
• anti-spasmodics
• etc.