Infectious diseases. Tetanus. Treatment. Prevention (most important)

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Infectious diseases. Tetanus. Treatment. Prevention (most important)

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20. Tetanus. Treatment. Prevention

Treatment. The main goal of treatment for tetanus is to eliminate the source of tetanospasmin formation, neutralize the toxin circulating in the blood, and conduct maintenance therapy until the tetanospasmin fixed by the nervous tissue is destroyed.

Human specific immunoglobunal (SIG) is administered as early as possible at a dose of 3000-6000 IU intramuscularly. Antitetanus immunoglobulin does not penetrate the blood-brain barrier and does not affect the toxin fixed in the nervous tissue. Its therapeutic effect is reduced only to the neutralization of tetanospasmin circulating in the blood.

In the absence of SIG and unchanged reactivity of the patient in accordance with the data of an intradermal test with tetanus antitoxin (CAT), the latter is recommended to be administered at a dose of 50-000 IU: half the dose - intramuscularly, the other half - intravenously.

Surgical measures for the treatment of wounds are carried out after the introduction of antitoxin and sedatives. Remove necrotic tissue and foreign bodies from the wound.

Antibiotic therapy helps to eliminate the vegetative forms of tetanus bacillus located in dead tissues. Usually large doses of penicillin G are prescribed intravenously in 6 doses for at least 10 days and try to ensure sufficient penetration of it into the lesions.

Muscle relaxants should be administered to all patients with tetanus. Diazepam (sibazon) is effective in reducing increased muscle tone and prevents convulsions. You can enter chlorpromazine or mefenesin, but their effect is less pronounced. Prevention. Active immunization is the best way to prevent tetanus. It is best to immunize women before pregnancy.

Children 6 years of age and older are immunized according to the method recommended for adults. Tetanus and diphtheria toxoids are administered intramuscularly in 3 divided doses. Primary immunization should be with tetanus toxoid. The introduction of at least 4 doses provides a sufficient level of immunity to tetanus.

Preventive measures after injury are determined by the immune status of the patient and the nature of the lesion itself. Surgical treatment of the wound should be carried out immediately and carefully. Patients who have not been actively immunized or who have been incomplete should be administered intramuscularly with human tetanus immunoglobulin at a dose of 250-500 IU. Skin allergy testing is optional. In the absence of SIG, tetanus antitoxin is injected intramuscularly at a dose of 3000-5000 IU, having previously tested for sensitivity to foreign proteins. The introduction of maintenance doses of toxoid is indicated when a child receives an injury 5 years or more after a full course of active immunization.

Author: Pavlova N.V.

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