Pediatric Tetanus Medication

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 9, 2012
 

Medication Summary

The goals of pharmacotherapy are to stop toxin production within the wound, to neutralize unbound toxin, and to control disease manifestations. Magnesium infusion may help relieve muscle spasm and diminish sedation requirements.[6]

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Antimicrobial agents

Class Summary

These agents are used to eradicate clostridia in the wound, which may cause toxin production.

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Metronidazole (Flagyl)

 

Antibacterial effects against clostridia. DOC for treatment of tetanus because of its safety profile, efficient penetration into wounds and abscesses, and negligible CNS excitation.

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Penicillin G (Pfizerpen)

 

Bactericidal antibiotic. Binds to and inhibits penicillin-binding proteins, which are transpeptidases that cross-link peptidoglycans, the final step in bacterial cell wall synthesis. Inhibits cell wall synthesis and autolytic enzyme activation are responsible for the bactericidal action on dividing bacteria.

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Erythromycin (E.E.S., E-Mycin, Eryc, EryPed, Erythrocin)

 

Bacteriostatic agent that inhibits protein synthesis by binding to the 50S subunit of bacterial ribosomes. Not the DOC for tetanus but may be used in case the DOCs for tetanus cannot be administered for some reason.

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Clindamycin (Cleocin)

 

Bacteriostatic agent that binds to 50S ribosomal subunit and acts as a bacteriostatic agent. Not the DOC for tetanus. May be used only if other DOCs cannot be used.

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Tetracycline (Sumycin)

 

Bacteriostatic agent that inhibits protein synthesis. Not the DOC for tetanus. May be used only if other DOCs cannot be used.

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Vancomycin (Vancocin)

 

Bacteriocidal agent that inhibits cell wall and RNA synthesis. Not the DOC for tetanus. May be used only if the DOCs cannot be used.

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Immunoglobulins

Class Summary

These agents are used for passive immunization of any person with a wound that might be contaminated with tetanus spores.

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Tetanus immune globulin, human (HyperTET S/D)

 

Administer as soon as the clinical diagnosis of tetanus is made. Neutralizes the circulating tetanus toxin.

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Vaccines

Class Summary

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components that act as antigens. Administration of the vaccine stimulates the production of antibodies with specific protective properties. Administer tetanus toxoid vaccine for wound prophylaxis if vaccine history is unknown or fewer than 3 tetanus toxoid immunizations have been administered.

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DTaP (Tripedia, Certiva, Infanrix)

 

May be administered into deltoid or midlateral thigh muscles in children and adults. In infants, preferred site of administration is the midlateral thigh muscles.

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Tdap (Adacel, Boostrix)

 

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. Promotes active immunity to diphtheria, tetanus, and pertussis by inducing production of specific neutralizing antibodies and antitoxins. Indicated for active booster immunization for tetanus, diphtheria, and pertussis prevention for persons aged 10-64 y (Adacel approved for ages 11-64 y, Boostrix approved for ages 10-18 y). Preferred vaccine for adolescents scheduled for booster.

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Skeletal Muscle Relaxant/Sedatives/Anesthetics

Class Summary

Benzodiazepines are used to control muscle spasms and to provide sedation. Dantrolene and baclofen may also be considered for severe spasticity and may assist with shortening duration of artificial ventilation. Recently, the use of propofol has been proposed.[7]

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Midazolam (Versed)

 

Shorter-acting benzodiazepine sedative-hypnotic useful in patients requiring acute and/or short-term sedation. Midazolam is also useful for its amnestic effects. Also provides antiepileptic effects.

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Baclofen (Lioresal)

 

Muscle relaxant (central), presynaptic GABA-B receptor agonist that may induce hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at spinal level. Lessens flexor spasticity and hyperactive stretch reflexes of upper motor neuron origin. Eliminated through renal excretion.

Effective in about 20% of patients. Appears to be of dramatic benefit in as many as 30% of children with dystonia, although benefit not always sustained.

Well absorbed, with average PO bioavailability of 60% and mean elimination half-life of 12 h; steady state reached within 5 d with multiple dose administration; metabolism occurs in liver (P 450-dependent glucuronidation and hydroxylation); 6 major and a few minor metabolites produced.

For intrathecal (IT) administration, a pump is implanted SC and a catheter implanted in subarachnoid space of spinal canal (where medication is administered). Less medication needed and systemic effects decreased. Half-life approximately 5 h.

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Dantrolene (Dantrium)

 

Acts peripherally at muscle fiber rather than at neural level; reduces muscle action potential–induced release of calcium and also affects intrafusal and extrafusal fibers and spindle sensitivity. Has no action on smooth or cardiac muscle tissue. Induces release of Ca++ into sarcoplasmic reticulum, subsequently decreasing the force of excitation coupling. Only drug that intervenes at a muscular level. Preferred for the cerebral form of spasticity. Less likely to cause lethargy or cognitive changes like baclofen or diazepam.

May reduce painful cramping and detrimental muscle tightening.

Can be administered PO/IV. IV form is much more expensive and should be reserved for patients unable to take PO medications. Most patients respond to 400 mg/d or less. Eliminated in the urine and bile.

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Propofol (Diprivan)

 

Phenolic compound that elicits sedative hypnotic effect. Used for induction and maintenance of anesthesia or sedation. Has also been shown to have anticonvulsant properties.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Rosemary Johann-Liang, MD  Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Sonali Ray, MD, to the development and writing of this article.

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Table. Guide to Tetanus Prophylaxis in Wound Management
History of Absorbed



Tetanus Toxoid



Clean Minor WoundsAll Other Wounds
Tetanus-diphtheria-acellular pertussisTIGTdapTIG
Unknown or < 3 dosesYesNoYesYes
3 or more dosesNoNoNoNo
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