Table 3.

Management of tetanus

Treatment	Purpose	Overview and recommendation
Aggressive wound care (surgical debridement, antibiotic treatment for the wound)	Prevention for toxin production	There are no trials to suggest the benefits of using antibiotics for tetanus treatment. Either penicillin or metronidazole may be used as the antibiotic choice in tetanus (expert opinion).
Agents Benzodiazepines Neuromuscular blockade Magnesium Intrathecal baclofen Dantrolene, ketamine, propofol, botulinum toxin Agents Clonidine, morphine, bupivacaine with sufentanil, labetalol Pacemaker (if bradycardic)	Reducing muscle spasms, controlling of autonomic instability and to avoid exhaustion	Benzodiazepines is readily available and used as standard of care (Favors use: expert opinion). Magnesium should be considered depending on clinician judgment. Meta‐analysis shows no mortality benefit (Evidence A), inadequate evidence in terms of positive impact on intensive care unit or hospital stay. Intrathecal baclofen may be harmful in lack of monitoring setting (Evidence C). Dantrolene, ketamine, propofol, botulinum toxin may be reasonable on a case by case. Clonidine, morphine, bupivacaine with sufentanil, labetalol may be reasonable on a case by case (Evidence C).
Immunoglobulins (TIG, IVIG)/tetanus toxoid (Td)	Neutralization of the circulating toxin immediately/Active immunization
Intubation, ventilation, and nutrition support appropriately	General support to prevent complication	Consider tracheotomy early case by case

Produced this table refer to Rodrigo et al. ³⁵

IVIG, intravenous immunoglobulin; TIG, tetanus immune globulin.