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7. Bacterial diseases
Treatment
H o sp italisatio n is necessary and requires 3 to 4 week s o n average. C o rrect
m anagem ent
can red uce m o rtality by 5 0 % , even in ho sp itals with lim ited reso urces.
General measures
– T h e p atient sh o uld be th e so le o ccup ant o f a d ark , quiet ro o m : all stim ulatio n
( no ise, ligh t, to uch) m ay trigger p ainful sp asm s th at m ay cause critical resp irato ry
d istress.
– H and le the p atient very carefully , und er sed atio n and as little as p o ssible; rep o sitio n
every 3 to 4 ho urs to p revent bed so res.
– E stablish IV access: hy d ratio n, access fo r I V injectio ns.
– Insert a naso gastric tube: hy d ratio n and feed ing; ad m inistratio n o f o ral m ed icatio ns.
– G entle asp iratio n o f secretio ns (no se, o ro p hary nx).
– P ro vid e hy d ratio n and nutritio n in feed s d ivid ed o ver 2 4 ho urs. In newbo rns, give
exp ressed breast m ilk every ho ur (risk o f hy p o gly caem ia).
Neutralisation of toxin
human tetanus immunoglobulin IM
Newbo rns, child ren and ad ults: 5 0 0 IU as a single d o se, injected into 2 sep arate sites
Inhibition of toxin production
T he treatm ent o f cho ice is metronidazole I V fo r 7 d ay s ( ad m inistered o ver 6 0 m in in
1
newbo rns) :
Newbo rns: o ne d o se o f 1 5 m g/ k g then, after 2 4 ho urs, 7 .5 m g/ k g every 12 ho u7rs
C hild ren: 7 .5 m g/ k g every 8 ho urs
A d ults: 5 0 0 m g every 8 ho urs
Control of rigidity and spasms, and sedation of the patient
D ue to increased risk o f resp irato ry d ep ressio n/ arrest wh en using h igh d o ses o f
d iaz ep am , th e p atient m ust alw ay s be k ep t und er co nstant clo se o bservatio n,
w ith im m ed iate availability o f equip m ent required fo r intubatio n and m anual
ventilatio n.
T he d o se and frequency o f ad m inistratio n d ep end o n the p atient‟s clinical resp o nse
and
to lerance (m o nito r resp irato ry rate o r o xy gen saturatio n).
F o r IV as well as fo r intra-rectal ad m inistratio n , d ilute 2 m l o f d iaz ep am (1 0 m g) in
diazepam
2
8 m l o f 5 % gluco se o r 0 .9 % so d ium chlo rid e.
C hild ren: 0 .1 to 0 .3 m g/ k g by slo w IV injectio n (o ver 3 to 5 m inutes) o r 0 .5
m g/ k g by
rectal ro ute, witho ut exceed ing 1 0 m g p er d o se, to be rep eated every 1 to 4 ho urs
A Bdenuzyltlspe:n1ici0llinmIV fogr b1y0 tosl1o4wdaIyVs moayrbientarna-arletecrtnaaltirvoe (usteecond choice):
1
Newborns: 80,000 IU/kg/day (50 mg/kg/day) in 2 injections every 12 hours
Infants: 125,000 IU/kg/day (75 mg/kg/day) in 3 injections every 8 hours
Children: 200,000 to 400,000 IU/kg/day (120 to 240 mg/kg/day) in 4 injections every 6 hours
FAodrurltesc:t1a0l aMdmIUi/ndisatyra(t6iogn/,duasye) ian s4yirninjegcetiownitshoeuvtenryee6dhleouorrscut a nasogastric tube, CH8, to a length of 2-3 cm and
Change to the oral route when possible with phenoxymethylpenicillin (penicillin V) by nasogastric tube.
Children: 62.5 mg/kg/day in 4 doses; adults: 2 g/day in 4 doses.
2
attach it to the tip of the syringe.
Treatment
H o sp italisatio n is necessary and requires 3 to 4 week s o n average. C o rrect
m anagem ent
can red uce m o rtality by 5 0 % , even in ho sp itals with lim ited reso urces.
General measures
– T h e p atient sh o uld be th e so le o ccup ant o f a d ark , quiet ro o m : all stim ulatio n
( no ise, ligh t, to uch) m ay trigger p ainful sp asm s th at m ay cause critical resp irato ry
d istress.
– H and le the p atient very carefully , und er sed atio n and as little as p o ssible; rep o sitio n
every 3 to 4 ho urs to p revent bed so res.
– E stablish IV access: hy d ratio n, access fo r I V injectio ns.
– Insert a naso gastric tube: hy d ratio n and feed ing; ad m inistratio n o f o ral m ed icatio ns.
– G entle asp iratio n o f secretio ns (no se, o ro p hary nx).
– P ro vid e hy d ratio n and nutritio n in feed s d ivid ed o ver 2 4 ho urs. In newbo rns, give
exp ressed breast m ilk every ho ur (risk o f hy p o gly caem ia).
Neutralisation of toxin
human tetanus immunoglobulin IM
Newbo rns, child ren and ad ults: 5 0 0 IU as a single d o se, injected into 2 sep arate sites
Inhibition of toxin production
T he treatm ent o f cho ice is metronidazole I V fo r 7 d ay s ( ad m inistered o ver 6 0 m in in
1
newbo rns) :
Newbo rns: o ne d o se o f 1 5 m g/ k g then, after 2 4 ho urs, 7 .5 m g/ k g every 12 ho u7rs
C hild ren: 7 .5 m g/ k g every 8 ho urs
A d ults: 5 0 0 m g every 8 ho urs
Control of rigidity and spasms, and sedation of the patient
D ue to increased risk o f resp irato ry d ep ressio n/ arrest wh en using h igh d o ses o f
d iaz ep am , th e p atient m ust alw ay s be k ep t und er co nstant clo se o bservatio n,
w ith im m ed iate availability o f equip m ent required fo r intubatio n and m anual
ventilatio n.
T he d o se and frequency o f ad m inistratio n d ep end o n the p atient‟s clinical resp o nse
and
to lerance (m o nito r resp irato ry rate o r o xy gen saturatio n).
F o r IV as well as fo r intra-rectal ad m inistratio n , d ilute 2 m l o f d iaz ep am (1 0 m g) in
diazepam
2
8 m l o f 5 % gluco se o r 0 .9 % so d ium chlo rid e.
C hild ren: 0 .1 to 0 .3 m g/ k g by slo w IV injectio n (o ver 3 to 5 m inutes) o r 0 .5
m g/ k g by
rectal ro ute, witho ut exceed ing 1 0 m g p er d o se, to be rep eated every 1 to 4 ho urs
A Bdenuzyltlspe:n1ici0llinmIV fogr b1y0 tosl1o4wdaIyVs moayrbientarna-arletecrtnaaltirvoe (usteecond choice):
1
Newborns: 80,000 IU/kg/day (50 mg/kg/day) in 2 injections every 12 hours
Infants: 125,000 IU/kg/day (75 mg/kg/day) in 3 injections every 8 hours
Children: 200,000 to 400,000 IU/kg/day (120 to 240 mg/kg/day) in 4 injections every 6 hours
FAodrurltesc:t1a0l aMdmIUi/ndisatyra(t6iogn/,duasye) ian s4yirninjegcetiownitshoeuvtenryee6dhleouorrscut a nasogastric tube, CH8, to a length of 2-3 cm and
Change to the oral route when possible with phenoxymethylpenicillin (penicillin V) by nasogastric tube.
Children: 62.5 mg/kg/day in 4 doses; adults: 2 g/day in 4 doses.
2
attach it to the tip of the syringe.
