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.