Human tetanus immune globulin for severe tetanus (adult)
Tetanus immune globulin (TIG, human) is recommended as a single intramuscular dose for treatment of clinical tetanus (Class I, Level of Evidence not stated) [1].
- Recommended dose: 500 international units (IU) IM once (single dose) [1].
- Dose equivalence note: Higher doses 3,000 to 6,000 IU have appeared similarly effective but cause more discomfort (optimal therapeutic dose uncertain) [1].
Metronidazole for severe tetanus (adult)
- Metronidazole: 2 g/day for 7 to 10 days [2].
Penicillin G for severe tetanus (adult)
- Crystalline penicillin G: 1 mega unit IV every 6 hours (QDS) for 10 days [2].
Diazepam for severe tetanus (adult)
- Diazepam: 10 to 60 mg IV or rectally four times daily (QDS) [2].
Magnesium sulfate for severe tetanus (adult)
- Magnesium sulfate: 70 mg/kg IV, followed by infusion with escalation by 0.5 g/hour every 6 hours until cessation of spasms or abolishment of patellar tendon jerk [3].
Key administration cautions
TIG is recommended to be administered intramuscularly [1].
Clinical management of severe tetanus typically requires aggressive supportive care because of life-threatening rigidity and autonomic instability [1].