Tetanus
Description General Measures Medicine Treatment Referral ICD-10 code: A35 *Notifiable medical condition. DESCRIPTION Painful muscle spasms and rigidity following inoculation by trauma of Clostridium tetani spores, which germinate and produce toxins. The wound may be trivial and healing may have occurred before presentation. Incubation period is 3-21 days. Tetanus may be localised, with mus
ICD-10 code: A35
*Notifiable medical condition.
DESCRIPTION
Painful muscle spasms and rigidity following inoculation by trauma of Clostridium tetani spores, which germinate and produce toxins. The wound may be trivial and healing may have occurred before presentation. Incubation period is 3-21 days. Tetanus may be localised, with muscle spasms near the site of inoculation, or generalised, with spasm of the jaw muscles being a common presenting sign.
GENERAL MEASURES
- These patients need to be managed in a high care setting where ventilation is available.
- Maintain and protect airway.
- Monitor ECG and blood pressure.
- Maintain and replace IV fluids.
- Wound management is essential with debridement and removal of any foreign bodies.
MEDICINE TREATMENT
For rigidity, spasms:
ICD-10 code: (R25.2)
- Diazepam, IV, 10 mg 4 hourly for 24 hours.
- Consider switch to oral therapy after 24 hours as prolonged parenteral diazepam administration can cause acidosis.
- Titrate to effect: doses as high as 50–100 mg two hourly may be required.
- Higher doses require monitoring for respiratory depression.
- Use muscle relaxants sparingly as these may exacerbate autonomic instability.
LoE:IIIbxxxv
Antibiotic treatment:
- Metronidazole, IV, 500 mg 8 hourly for 10 days.
LoE:IIIbxxxvi
For passive immunisation:
ICD-10 code: (Z23.5)
- Tetanus immunoglobulin, IM, 3 000 units as a single dose.
For active immunisation of all patients: (as clinical tetanus does not always confer immunity)
ICD-10 code: (Z23.5)
- Tetanus toxoid vaccine, IM, 0.5 mL, total of 3 doses:
- on admission,
- at 4 weeks, and
- at 6 months.
- Administer at a different site to that used for administering tetanus immunoglobulin.
For pain:
- Paracetamol, oral, 500 mg -1 g 4–6 hourly when required (to a maximum of 4 g in 24 hours).
- Maximum dose: 15 mg/kg/dose.
- Morphine, IV, to a total maximum dose of 10 mg (See: Prescribing Information for Specific Medicines for individual dosing and monitoring for response and toxicity).
LoE:IIaxxxvii
For shock, dehydration, maintenance of hydration:
ICD-10 code: R57.9 + (A35)
- IV fluids.
For prophylaxis for deep vein thrombosis:
ICD-10 code: (Z29.2)
See Venous thrombo-embolism - Prophylaxis
REFERRAL
All cases to a facility with resources for artificial mechanical ventilation.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025
Chapter 9 Systemic and Healthcare-Associated Infections_9.9 Tetanus