Volume 99, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Tetanus, a vaccine-preventable and potentially fatal disease, continues to remain prevalent in low- and middle-income countries. Furthermore, physicians are often unfamiliar with management of severe tetanus without ventilator support. Therefore, we proposed a modified treatment protocol that provides a low-cost and effective solution for the management of severe tetanus in resource-constrained settings. This is an observational study of 42 patients with severe tetanus treated during 2015–2016 at Surya Kanta Hospital, Bangladesh. This facility does not have an intensive care unit (ICU), and patients admitted here were provided treatment with the modified protocol. A total number of 42 patients with severe tetanus were treated with the modified protocol. Among them, 24 (57.1%) recovered completely, six (14.3%) recovered with the sequela, and 12 (28.6%) died. Among those who recovered with the sequela, four needed mechanical support during walking and two had a visual impairment. No significant adverse event was recorded during the treatment period. The results gathered during this case series provide a sustainable, low-cost, and effective solution to management of severe tetanus in resource-constrained settings where ICUs are unavailable.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE, Gilyoma JM, , 2011. Ten-year experiences with tetanus at a tertiary hospital in northwestern Tanzania: a retrospective review of 102 cases. World J Emerg Surg 6: 20. [Google Scholar]
  2. Brauner JS, Vieira SR, Bleck TP, , 2002. Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil. Intensive Care Med 28: 930935. [Google Scholar]
  3. Joshi S, Agarwal B, Malla G, Karmacharya B, , 2007. Complete elimination of tetanus is still elusive in developing countries: a review of adult tetanus cases from referral hospital in eastern Nepal. Kathmandu Univ Med J 5: 378381. [Google Scholar]
  4. Chukwubike OA, God’spower AE, , 2009. A 10-year review of outcome of management of tetanus in adults at a Nigerian tertiary hospital. Ann Afr Med 8: 168172. [Google Scholar]
  5. Kyu HH, Mumford JE, Stanaway JD, Barber RM, Hancock JR, Vos T, Murray C, Naghavi M, , 2017. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study. BMC Public Health 17: 179. [Google Scholar]
  6. Okoromah CN, Lesi FE, , 2004. Diazepam for treating tetanus. Cochrane Database Syst Rev 1: CD003954. [Google Scholar]
  7. Yen LM, 1997. Management of Tetanus: A Comparison of Penicillin and Metronidazole. Symposium of Antimicrobial Resistance in Southern Viet Nam, Ho Chi Minh City, Vietnam.
  8. Altura BM, Altura BT, , 1981. Magnesium ions and contraction of vascular smooth muscles: relationship to some vascular diseases. Fed Proc 40: 26722679. [Google Scholar]
  9. James MF, Manson ED, , 1985. The use of magnesium sulphate infusions in the management of very severe tetanus. Intensive Care Med 11: 512. [Google Scholar]
  10. Attygalle D, Rodrigo N, , 1997. Magnesium sulphate for control of spasms in severe tetanus. Can we avoid sedation and artificial ventilation? Anaesthesia 52: 956962. [Google Scholar]
  11. Attygalle D, Rodrigo N, , 2002. Magnesium as first line therapy in the management of tetanus: a prospective study of 40 patients. Anaesthesia 57: 811817. [Google Scholar]
  12. Thwaites CL, Yen LM, Loan HT, Thuy TTD, Thwaites GE, Stepniewska K, Soni N, White NJ, Farra JJ, , 2006. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet 368: 14361443. [Google Scholar]
  13. Osalusi BS, Ogun SA, Ogunniyi A, Kolapo KO, , 2008. Comparison of the efficacy of magnesium sulphate and diazepam in the control of tetanus spasms. Sci Res Essays 3: 571576. [Google Scholar]
  14. Ali G, Kamal M, Khan AN, , 2011. Comparison of the efficacy of magnesium sulphate and diazepam in the control of tetanus spasm. J Postgrad Med Inst 25: 106110. [Google Scholar]
  15. Kole AK, Roy R, Kar SS, Kole DC, , 2013. Experience of use of magnesium sulfate in the treatment of tetanus in a tertiary referral Infectious Disease Hospital, Kolkata, India. Ann Trop Med Public Health 6: 456459. [Google Scholar]
  16. WHO Vaccine-Preventable Disease Monitoring System, 2016. Global Summary. Available at: http://www.who.int/immunization/monitoring_surveillance/data/en/. Accessed December 12, 2017.
  17. Chaudhry R, Dhawan B, Mohanty S, Dey AB, , 2001. Tetanus in the elderly: a forgotten illness. Lancet 1805: 357. [Google Scholar]
  18. Norredam K, Hainau B, , 1970. Treatment of tetanus in tropical Africa: a comparison between a barbiturate and diazepam in the treatment of non-neonatal tetanus. Ann Soc Belges Med Trop Parasitol Mycol 50: 239246. [Google Scholar]
  19. Joseph A, Pulimood BM, , 1978. Use of diazepam in tetanus—a comparative study. Indian J Med Res 68: 489491. [Google Scholar]
  20. Karanikolas M, Velissaris D, Marangos M, Karamouzos V, Fligou F, Filos KS, , 2010. Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series. J Med Case Rep 4: 100. [Google Scholar]
  21. Mathew PJ, Samra T, Wig J, , 2010. Magnesium sulphate for treatment of tetanus in adults. Anaesth Intensive Care 38: 185189. [Google Scholar]

Data & Media loading...

  • Received : 28 Feb 2018
  • Accepted : 12 Jul 2018
  • Published online : 10 Sep 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error