Table 3:

Management of tetanus³

Goal	Treatment
Stop toxin production	Wound care, including débridement if necessary Antimicrobial therapy targeting Clostridium tetani
Neutralize unbound toxin	Tetanus immune globulin Active immunization with tetanus toxoid
Control of muscle spasms	Intravenous benzodiazepines Long-term neuromuscular blockade for refractory tetany
Management of dysautonomia	β-blockers, morphine, epidural blockade and/or magnesium sulfate for sympathetic hyperactivity Pacemaker if bradycardic
General supportive measures	Intubation and ventilation; consider early tracheotomy Adequate nutrition Prevention of nosocomial complications