Treatment and prevention of tetanus

Treatment of tetanus should be accompanied by a curative-protective regime, which helps reduce the frequency of convulsive attacks. Patients are accommodated in separate wards, isolating as much as possible from external irritants capable of provoking convulsions.

Of great importance is a full-fledged enteral (probe) and / or parenteral nutrition with special nutritional mixtures: Nutrizond, Isocal HCN, Osmolite HN, Pulmocare, concentrated solutions of glucose (10-70%), amino acid mixtures and fatty emulsions. The food is provided from the calculation (taking into account the large energy expenditure with convulsions and high temperature) 2500-3000 kcal / day.

Etiotropic treatment of tetanus is very limited. Surgical treatment of wounds is performed to remove nonviable tissues, foreign bodies, open pockets, create an outflow of wound detachable, which prevents the further development of toxin by the pathogen. Before treatment, the wound is treated with tetanus antitetanum in a dose of 1000-3000 IU. Surgical manipulations are performed under general anesthesia to avoid seizures.

To neutralize the circulating exotoxin, intramuscularly single-dose 50-100 thousand ME of tetanus antitetanus purified concentrated whey or, more preferably, is administered. 900 IU tetanus immunoglobulin. The toxin fixed in tissues can not be influenced by any means. According to several authors, neither the early, nor the repeated administration of these drugs does not prevent the development of severe forms and death of the disease. Therefore pathogenetic methods of therapy play an important role.

With moderate and severe tetanus, it is necessary to prescribe muscle relaxants, so patients are immediately transferred to mechanical ventilation. It is preferable to use long-acting antidepolarizing muscle relaxants: tubocurarine chloride 15-30 mg / h, alcuronium chloride 0.3 mg / kg-kg, pipecuronium bromide 0.04-0.06 mg / kg-h, atrakuronium besylate 0, 4-0.6 mg / (kg-h). Since ALV is carried out in prolonged mode (up to 3 weeks), it is advisable to use tracheostomy and modern respiratory equipment with high-frequency ventilation systems and positive exhalation pressure.

In addition, anticonvulsant tetanus treatment should be used. In mild and moderate forms of the disease, patients are parenterally injected with neuroleptics (aminazine up to 100 mg / day, droperidol up to 10 mg / day), tranquilizers (diazepam up to 40-50 mg / day), chloral hydrate (up to 6 g / day in enemas). They are used both in isolation and in combination with narcotic analgesics (neuroleptanalgesia), antihistamines (diphenhydramine 30-60 mg / day, promethazine and chlorpyramine 75-150 mg / day), barbiturates (sodium thiopental and hexobarbital up to 2 g / day) . These daily doses of drugs are administered intramuscularly or intravenously in 3-4 sessions. The combined administration of drugs potentiates their effect. The beta-adrenoblocker (propranolol, bisoprolol, atenolol) is shown to reduce the influence of the sympathetic nervous system. When using muscle relaxants, it is necessary to use anti-bedsore mattresses and perform regular chest massage to reduce the likelihood of developing pneumonia.

Antibiotics should be given to patients with severe tetanus forms for the prevention and treatment of pneumonia and sepsis. Preference is given to semisynthetic penicillins (ampicillin + oxacillin 4 g / day, carbenicillin 4 g / day), cefalasporin II and III generations (cefotaxime, ceftriaxone at a dose of 2-4 g / day, cefuroxyu 3 g / day), fluoroquinolones (ciprofloxacin, levofloxacin 0.4 g / day) and other broad-spectrum antibiotics.

In case of severe disease, anti-hypovolaemia is indicated for infusion therapy for tetanus (crystalloids) under the control of hematocrit, hemodynamic parameters such as central venous pressure, pulmonary capillary wedge pressure, cardiac output, and total peripheral vascular resistance. The use of funds improving microcirculation (pentoxifylline, nicotinic acid) and decreasing metabolic acidosis (sodium bicarbonate solution at calculated doses) is shown. Effective use of hyperbaric oxygenation, immunoglobulins - human immunoglobulin normal (pentaglobin) and metabolic agents (large doses of water-soluble vitamins, trimetazidine, meldonium, anabolic steroids). With prolonged ventilation, the issues of caring for the patient come to the fore.

Approximate terms of incapacity for work

Determine individually.

[1], [2], [3], [4], [5], [6], [7]

Clinical examination

Not regulated.

[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]

How to prevent tetanus?

Specific prevention of tetanus

The vaccination calendar provides for a three-time vaccination of children with an interval of 5 years, using a tetanus vaccination. In developing countries, vaccination of women of childbearing age is important for the prevention of neonatal tetanus. A tetanus toxoid or an associated DTP vaccine is used. Since in each specific case the degree of immunity is unknown and some part of the population is not vaccinated, in case of the threat of the development of the disease, emergency prevention is necessary. For this purpose, thorough primary and surgical treatment of wounds is performed, with traumas with violations of the integrity of the skin and mucous membranes, burns and frostbites of II-III degree, animal bites, community labor and abortions, enter heterogeneous tetanus antitetanum in a dose of 3000 ME or highly active tetanus antiglottin dose of 300 IU. Passive immunization does not always prevent the disease, which requires active immunization with tetanus toxoid at a dose of 10-20 ME. Serum and anatoxin should be administered to different parts of the body.

Nonspecific prevention of tetanus

Great importance is the prevention of injuries.

What is the prognosis of tetanus?

Tetanus always has a serious prognosis. Timely treatment of tetanus and its quality also affects the prognosis of this disease. Without treatment, lethality reaches 70-90%, but even with adequate and timely intensive care is 10-20%, and in newborns - 30-50%. In convalescents observed prolonged asthenia, in uncomplicated cases there is a complete physical recovery. Fractures and pronounced deformities of the spine can lead to disability.