Diazepam for treating tetanus

Okoromah, Christy A. N.; Lesi, Afolabi Fe

doi:10.1002/14651858.cd003954

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Diazepam modulates GABA-A transmission and increases presynaptic inhibition. In a Cochrane review to assess the relative efficacy of diazepam in the treatment of tetanus in adults and children, Okoromah and Lesi [17] concluded that using diazepam was associated with better survival rate in children when compared to a combination of phenobarbitone and chlorpromazine (relative risk for death 0.36, 95% confidence interval 0.15 to 0.86; risk difference −0.22, 95% confidence interval −0.38 to −0.06). However, despite searching for all randomized and quasi randomized trials in many databases, they only managed to find two trials matching the inclusion criteria (n = 134) demonstrating the paucity of evidence for pharmacological therapy in tetanus.…”

Section: Results/reviewmentioning

confidence: 99%

Pharmacological management of tetanus: an evidence-based review

2014

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Tetanus is becoming rarer in both industrialized and developing nations due to an effective vaccination program. In 2010, the World Health Organization estimated there was a 93% reduction in newborns dying from tetanus worldwide, compared to the situation in the late 1980s. Due to its rarity, many diagnostic delays occur as physicians may not consider the diagnosis until the manifestations become overt. Without timely diagnosis and proper treatment, severe tetanus is fatal (mortality is also influenced by the comorbidities of the patient). The principles of treating tetanus are: reducing muscle spasms, rigidity and autonomic instability (with ventilatory support when necessary); neutralization of tetanus toxin with human antitetanus immunoglobulin or equine antitetanus sera; wound debridement; and administration of antibiotics to eradicate locally proliferating bacteria at the wound site. It is difficult to conduct trials on different treatment modalities in tetanus due to both logistical and ethical reasons. However, it is imperative that physicians are aware of the best evidence-based treatment strategies currently available to improve the outcome of patients. This review concentrates on analyzing the current evidence on the pharmacological management of tetanus.

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Section: Results/reviewmentioning

confidence: 99%

Pharmacological management of tetanus: an evidence-based review

2014

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“…16 A meta-analysis of studies on children with tetanus reported diazepam alone is more beneficial on controlling tenues and reducing mortality than if it is combined with phenobarbital (RR of death 0.36; 95% CI 0.15-0.86; risk difference 12.22; 95% CI −0.38 to −0.06). 17 However, the combination of diazepam and phenobarbital compered to diazepam alone has demonstrated a significantly shorter clinical course and hospitalization. 18 This evidence confirming the efficacy and safety of phenobarbital in tetanus management, which suggests adding phenobarbital to primary treatment of severe tetanus could be a favorable choice.…”

Section: Discussionmentioning

confidence: 99%

Successful management of severe generalized tetanus in a 23‐year man with phenobarbital adjuvant: A case report

Ahmadi,

Karimpour‐Razkenari,

Ansari

et al. 2023

Clinical Case Reports

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Key Clinical MessageGeneralized tetanus is still a global concern with a mortality rate of up to 50%, especially in low and middle‐income countries. We reported a 23‐year‐old man from Afghanistan admitted to emergency department, with the chief complaint of generalized severe spasms and lockjaw. The patient had skin lesions and had never been vaccinated against tetanus. He intubated and admitted to the intensive care unit (ICU) with diagnose of severe generalized tetanus. After receiving tetanus immunoglobulin and intravenous metronidazole, a combination therapy of midazolam, propofol, atracurium, and morphine was administered. Due to the refractory muscular spasms intravenous phenobarbital started and little by little recovery was achieved. The patient receiving the first two doses of the Td vaccine, and discharged on Day 42 of hospitalization with no symptom recurrence. This case management showed adding phenobarbital to severe tetanus treatment regimen could significantly reduce refractory spasm caused by tetanus, also decrease other medication requirement.

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“…Recently, I have shown that mega-dose enteral diazepam (ranging from 6 to 180 mg) can control dyskinesia effectively [8]. Previously, diazepam has demonstrated muscle-relaxant properties in neuroleptic malignant syndrome and tetanus [9,10]. In the severe form of dyskinesia resulting from NMDAR encephalitis, mega-dose diazepam decreased the severity of dyskinesia to tolerable levels and no patients had serious adverse events except mild sedation [8].…”

Section: Dyskinesiamentioning

confidence: 99%

Symptomatic treatments of N-methyl-D-aspartate receptor encephalitis

Lee

2020

encephalitis

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N -methyl-D-aspartate receptor (NMDAR) encephalitis presents with multiple symptoms including memory loss, seizure, psychosis, aphasia, altered mentality, dyskinesia, autonomic dysfunction, and central hypoventilation. While immunotherapy protocols are improving, morbidity and mortality in the disease largely depend on supportive care to control intractable symptoms. However, no prospective or controlled trials have been conducted on immunotherapy or supportive care principles in the disease. Thus, this study discusses and shares experience and ideas for symptomatic care of NMDAR encephalitis.

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Diazepam for treating tetanus

Cited by 5 publications

References 19 publications

Pharmacological management of tetanus: an evidence-based review

Pharmacological management of tetanus: an evidence-based review

Successful management of severe generalized tetanus in a 23‐year man with phenobarbital adjuvant: A case report

Symptomatic treatments of N-methyl-D-aspartate receptor encephalitis

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