Comparative clinical trial of diazepam with other conventional drugs in tetanus

Abstract

SummaryResults of therapeutic trial of diazepam in tetanus are presented. The trial included 200 cases of tetanus-167 non-neonates and thirty-three neonates. The patients were divided into two groups and were matched as regards age, sex and severity of the disease. The cases of group I received standard treatment while the cases of group II received diazepam in addition. Over-all mortality in group I was 54% and in group II, 26 %. The results were statistically significant in non-neonates and in severe degree of tetanus. The drug was well tolerated and side effects were not observed.

Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil

“…The higher incidence of hypertension and arrhythmia detected in group 2 was probably related to the use of modern continuous non-invasive pressure and EKG monitoring, allowing the detection of tachyarrhythmias and bradyarrhythmias that forecast cardiac arrest. Although no therapeutic regimens have proved to be universally effective in the treatment of hyperadrenergic activity, some have been proposed, such as reposition of volume, deep sedation with higher doses and longer duration of treatment with benzodiazepines [17,18,19], use of chlorpromazine, β-adrenergic blocking agents, morphine, and clonidine [20,21,22,23]. In our study we tried to improve this treatment by using higher doses of diazepam and lower doses of curare, given that pancuronium could worsen tachycardia and hypertension [24]; avoiding propranolol (used in group 1), whose use can be related to sudden death, hypotension, and severe pulmonary oedema [25,26,27]; using morphine (used in group 2), which is related to better cardiovascular stability [24,28].…”

Tetanus Toxin

“…[63][64][65][66][67][68][69][70][71][72][73][74] In extreme cases, or if benzodiazepines fail, generalized tonic activity may respond to curare-like agents including vecuronium, with a long half-life and less cardiovascular side effects, [75][76][77] or succinylcholine if rapid initial muscle paralysis is needed. Benzodiazepines are the drug of choice, sometimes requiring extremely large dosages, typically infused intravenously.…”