Editing Tetanus (section)

==Treatment==
[[File:Tetanus world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Tetanus deaths per million persons in 2012{{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|0–1}}{{legend|#ffa020|1–2}}{{legend|#ff9a20|2–3}}{{legend|#f08015|4–8}}{{legend|#e06815|9–13}}{{legend|#d85010|14–28}}{{legend|#d02010|29–151}}{{div col end}}
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=== Mild tetanus ===
Mild cases of tetanus can be treated with:<ref name="World Health Organization">{{cite web|last=World Health Organization|title=Current recommendations for treatment of tetanus during humanitarian emergencies|url=https://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/|work=Disease Control in Humanitarian Emergencies (English)|publisher=WHO|access-date=12 June 2013|url-status=dead|archive-url=https://web.archive.org/web/20140313073904/http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/|archive-date=13 March 2014}}</ref>
* [[Tetanus immunoglobulin]] (TIG),<ref name="CDC2012Pink"/> also called ''tetanus antibodies'' or ''tetanus antitoxin.''<ref name=britannica2013>[http://global.britannica.com/EBchecked/topic/588853/tetanus-antitoxin tetanus] in [[Encyclopædia Britannica]]. Last Updated 7-17-2013</ref> It can be given as [[intravenous therapy]] or by [[intramuscular injection]].
* Antibiotic therapy to reduce toxin production. [[Metronidazole]] intravenous (IV) is a preferred treatment.<ref name="World Health Organization" />
* [[Benzodiazepines]] can be used to control muscle spasms. Options include [[diazepam]] and [[lorazepam]], oral or IV.<ref name="World Health Organization" />

=== Severe tetanus ===
Severe cases will require admission to [[intensive care]]. In addition to the measures listed above for mild tetanus:<ref name="World Health Organization"/>
* Human tetanus immunoglobulin injected [[intrathecal]]ly (which increases clinical improvement from 4% to 35%).
* [[Tracheotomy]] and [[mechanical ventilation]] for 3 to 4 weeks. Tracheotomy is recommended for securing the airway, because the presence of an endotracheal tube is a stimulus for spasm.
* [[Magnesium sulfate (medical use)|Magnesium sulfate]], as an intravenous infusion, to control spasm and autonomic dysfunction.
* [[Diazepam]] as a continuous IV infusion.
* The [[Autonomic nervous system|autonomic]] effects of tetanus can be difficult to manage (alternating hyper- and [[hypotension]] [[hyperpyrexia]]/[[hypothermia]]), and may require IV [[labetalol]], magnesium, [[clonidine]], or [[nifedipine]].

Drugs, such as diazepam or other [[muscle relaxant]]s, can be given to control the muscle spasms. In extreme cases, it may be necessary to paralyze the person with [[curare]]-like drugs, and use a mechanical ventilator.{{citation needed|date=June 2022}}

To survive a tetanus infection, the maintenance of an airway and proper [[nutrition]] are required. An intake of {{convert|3500|to|4000|Cal}} and at least 150&nbsp;g of protein per day is often given in liquid form through a tube directly into the stomach ([[percutaneous endoscopic gastrostomy]]), or through a drip into a vein ([[parenteral nutrition]]). This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity. Full recovery takes 4 to 6 weeks because the body must regenerate destroyed nerve [[axon]] terminals.<ref>{{Cite web |date=2014-12-31 |title=Tetanus – CheckOrphan |url=https://checkorphan.org/disease/tetanus/ |access-date=2024-09-06 |language=en-US}}</ref>

The antibiotic of choice is [[metronidazole]]. It can be given intravenously, by mouth, or by rectum.<ref>{{cite book|last1=Thwaites|first1=C. Louise|last2=Yen|first2=Lam Minh |editor=J. Larry Jameson|others=Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, Joseph Loscalzo|title=Harrison's Principles of Internal Medicine | edition = Twentieth | volume = 1 and 2 |url=https://books.google.com/books?id=XGQntQEACAAJ|date=13 August 2018|publisher=McGraw-Hill Education|isbn=978-1-259-64403-0|chapter=Tetanus|page=2884}}</ref><ref name="World Health Organization"/> Of likewise efficiency is [[penicillin]], but some raise the concern of provoking spasms because it inhibits [[gamma-Aminobutyric acid|GABA receptor]], which is already affected by tetanospasmin.<ref>{{cite journal | vauthors = Rodrigo C, Fernando D, Rajapakse S | title = Pharmacological management of tetanus: an evidence-based review | journal = Critical Care | volume = 18 | issue = 2 | pages = 217 | date = March 2014 | pmid = 25029486 | pmc = 4057067 | doi = 10.1186/cc13797 | publisher = Springer Science and Business Media LLC | doi-access = free }}</ref>