Key points
- Tetanus is a medical emergency that requires hospitalization.
- Tetanus treatment often involves several types of medications and supportive care.
- Complete recovery can take several months.
- Tetanus infection doesn't provide immunity, so vaccination is recommended during recovery.
Treatment recommendations
Maintain an airway
Healthcare providers should monitor for airway patency because associated muscle spasms can cause airway loss. Depending on disease severity, endotracheal intubation or tracheostomy- and mechanically-assisted respiration may be lifesaving.
Administer tetanus immune globulin
Medical experts recommend a single, 500 international unit (IU) dose of human tetanus immune globulin (TIG) for tetanus treatment. While the optimal therapeutic dose is uncertain, this dose appears as effective as higher doses (3,000 to 6,000 IU). It also causes less discomfort. TIG helps remove unbound tetanus toxin from the body. It cannot affect toxin already bound to nerve endings.
Administer TIG preparations intramuscularly. TIG preparations available in the United States aren't licensed or formulated for intrathecal or intravenous use.
Some medical experts recommend infiltration of part of the dose locally around the wound, although its efficacy hasn't been proven.1
If TIG isn't available, healthcare providers can use immune globulin intravenous (IGIV) (dose 200 to 400 milligrams per kilogram). Note, the Food and Drug Administration hasn't approved IGIV for this use. In addition, anti-tetanus antibody content varies by lot.
Control muscle spasms
Healthcare providers should use sedation and muscle relaxant drugs as indicated to control muscle spasms. Patients may require agents to control autonomic nervous system instability.
Manage wounds and treat infections
Clean all wounds. Remove or debride necrotic tissue. Remove any foreign material. Observe wounds for signs of infection. Promptly treat infected wounds.
Provide antimicrobial therapy
Appropriate antibiotic therapy is recommended to reduce the number of bacteria.
Promoting long-term wellness after treatment
Vaccinate during recovery
Tetanus disease doesn't result in tetanus immunity. Vaccination, if indicated, is recommended as soon as the patient's condition has stabilized. Healthcare providers should begin or continue active immunization with a tetanus toxoid-containing vaccine.
- American Academy of Pediatrics. Tetanus. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: Report of the Committee on Infectious Diseases. 2021.