Lockjaw - Treating tetanus

It is important that tetanus is treated quickly to prevent complications from developing.

There are two types of treatment for tetanus:

preventative treatment - for people who are thought to be fully or partially vaccinated against tetanus and who have an injury that makes them vulnerable to a tetanus infection
symptomatic treatment - for people who have developed the symptoms of an active tetanus infection

Preventative treatment

Wounds that are vulnerable to a tetanus infection are called tetanus-prone wounds.

Tetanus-prone wounds

Tetanus-prone wounds include:

wounds or burns that required surgery to repair, but access to surgery was delayed for six hours or more
wounds or burns that cause a significant amount of tissue loss
puncture injuries, particularly if they may have become contaminated with soil or manure
wounds that contain foreign bodies, such as an animal’s tooth
severe bone fractures that may have left the bones vulnerable to infection
wounds and burns in patients who have systemic sepsis (a fall in blood pressure as a result of a serious bacterial infection)

Medication called tetanus immunoglobulin (TIG) is recommended if you have a tetanus-prone wound and there is a high risk that it could be contaminated by tetanus bacteria. This might be the case if the wound came into contact with soil or animal waste.

The use of TIG is recommended even if your vaccinations are up to date. There may be a very small chance that the vaccine did not give you total immunity against tetanus.

Tetanus immunoglobulin

Tetanus immunoglobulin (TIG) is a medication that contains antibodies that kill the tetanus bacteria. Antibodies are infection-fighting proteins. Tetanus immunoglobulin is given as an injection into a muscle and gives immediate, short-term protection against tetanus. It is thought to be safe to use in pregnant and breastfeeding women.

After having tetanus immunoglobulin, you are likely to have some short-term discomfort at the site of the injection. Other side effects are thought to be uncommon but may include:

chest pain
shortness of breath
dizziness
swelling of your face
mouth ulcers
shaking
joint pains

Speak to the doctor in charge of your care if you develop any of these side effects.

Depending on whether your vaccinations are up to date, you may also be given a booster dose of the tetanus vaccine.

Treating tetanus symptoms

If someone develops the symptoms of tetanus, they will need to be admitted to hospital.

Because tetanus is rare in the UK, an infected person may be transferred to one of the larger NHS hospitals, where doctors with experience in treating tetanus are usually based.

The three main types of medication used to treat the symptoms of tetanus are:

sedatives
muscle relaxants
neuromuscular blocking agents (NBAs)

Sedatives

Sedatives are a type of medication that make you feel physically and mentally relaxed. They relax the muscles, which can help relieve and prevent muscle stiffness.

Side effects of sedatives include:

drowsiness
irritability
depression
shaky movements and an unsteady walk (ataxia)
hyperactivity
seeing or hearing things that are not real (hallucinations)

Muscle relaxants

Muscle relaxants are a type of medication that help relax the muscles. They are often used when treatment with sedatives is withdrawn (sedatives can be addictive so they are not usually recommended as a long-term treatment).

You will be given muscle relaxants to stop your symptoms returning when your dose of sedatives are reduced.

Neuromuscular blocking agents (NBAs)

Neuromuscular blocking agents (NBAs) are a type of medication that block nerve signals sent from the brain to the muscles. This leads to an inability to move certain muscles (paralysis), which can be useful in people with severe muscle spasms and stiffness.

A neuromuscular blocking agent called vecuronium is usually prescribed. Vecuronium causes paralysis of the muscles used for breathing, so assistance with breathing is provided before it can be given.

Preventing further spread of neurotoxins

Tetanus immunoglobulin can be used to prevent the tetanospasmin neurotoxin causing further damage and disruption to your nervous system. Antibiotics such as penicillin (or metronidazole if you are allergic to penicillin) are also used to try to kill any bacteria and prevent any further toxins being released.

Surgery

If a tetanus-prone wound is particularly large, it may be necessary to remove as much of the damaged and contaminated muscle as possible using a surgical procedure called debridement.

Debridement involves cleaning an open wound by removing foreign material, such as dirt and manure, as well as any dead tissue. In the case of a tetanus infection, debridement will remove any remaining tetanus bacteria.

Nutrition and breathing

The increased muscle activity caused by tetanus means that a person with the infection needs to consume a high amount of calories. An intake of 3,500 to 4,000 calories a day is often required, plus 150g of protein a day.

If swallowing is difficult or not possible, it may be necessary to give a liquid feed through a tube connected to the stomach or through a drip into a vein. Help with breathing may also be required using a ventilator (a machine that helps you breathe).