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anus

In the case o f severe sp asm s no t co ntro lled by interm ittent d o sing, d iaz ep am m ay be
ad m inistered by co ntinuo us IV infusio n (excep t in infants less than 1 m o nth), und er
co nstant clo se o bservatio n.
C h ild ren o ver 1 m o nth and ad ults: 3 to 1 0 m g/ k g/ d ay , th e d o se is to be ad justed
acco rd ing to clinical resp o nse.

Control of pain

In early stage, if necessary ; the risk o f resp irato ry d ep ressio n is increased , thus clo ser
m o nito ring is required :
morphine slo w IV (5 m inutes)
Newbo rns: 0 .0 5 m g/ k g every 6 ho urs if need ed
C hild ren fro m 1 to 6 m o nths: 0 .1 m g/ k g every 6 ho urs if need ed
C hild ren o ver 6 m o nths and ad ults: 0 .1 m g/ k g every 4 ho urs if need ed

Treatment of the entry site

A sy stem atic search sh o uld be m ad e fo r th e entry w o und . P ro vid e lo cal treatm ent
und er sed atio n: cleansing, and fo r d eep wo und s, irrigatio n, d ebrid em ent.
C o rd infectio n: d o no t excise o r d ebrid e; treat bacterial o m p halitis.

Tetanus vaccination

A s tetanus d o es no t co nfer im m unity , vaccinatio n against tetanus m ust be ad m inistered
o nce the p atient has reco vered .
In case o f neo natal tetanus, initiate the vaccinatio n o f the m o ther.

Prevention

O f critical im p o rtance, given the d ifficulty o f treating tetanus o nce established .

1) Post-exposure prophylaxis

– In all cases:
• C leansing and d isinfectio n o f the wo und , and elim inatio n o f fo reign m aterial.
• A ntibio tics are no t p rescribed ro utinely fo r p ro p hy laxis. T he d ecisio n to ad m inister
an antibio tic ( m etro nid az o le o r p enicillin) is m ad e o n a case- by - case basis,
acco rd ing to the p atient‟s clinical status.

– D ep end ing o n p re-exp o sure vaccinatio n status:
• tetanus vaccine (T V ) 3 and im m uno glo bulin: see ind icatio ns belo w.

Complete vaccination (3 o r m o re d o ses) Incomplete vaccination

R isk T im e since ad m inistratio n o f latest d o se: (less than 3 d o ses)

< 5 y ears 5 -1 0 y ears > 1 0 y earso rno vaccination o runknown status

M ino r clean No ne No ne TV
wo und o ne bo o ster Initiate o r co m p lete T V

d o se

A ll o ther T V T V Initiate o r co m p lete T V
wo und s
No ne o ne bo o ster o ne bo o ster and

d o se d o se A d m inister tetanus im m uno glo bulin

3 Tetanus-containing vaccine, such as TT or DT or dT or DTP or DTP + HepB or DTP + Hib + HepB according to
availability and patient‟s age.

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