Cochrane Summaries

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Diazepam for treating tetanus

Okoromah CAN, Lesi AFE
Published Online: 
21 January 2009

Tetanus is a disease caused by bacteria (Clostridium tetani) found in soil and faeces. It can be immunised against but continues to kill children and adults. Newborn infants are the most vulnerable, particularly in Bangladesh, India, Indonesia, Nigeria and Pakistan, mainly because of unhygienic umbilical cord practices. Puncture wounds, burns, multiple ear piercing, tattooing and circumcision (male and female) can also cause tetanus infection. The symptoms include a sudden onset of muscle stiffness and spasms (involuntary contractions) in the neck, jaw and back, sufficient to cause rigid arching of the back. Glottal and laryngeal spasms may result in fluid being sucked into the breathing passages (aspiration) or inability to breathe (asphyxiation). These spasms progress over two weeks and recovery then takes some four weeks. Complications of the disease or its treatment include depressed breathing, extrapyramidal signs that mimic the tetanus spasms and rigidity, body (autonomic) dysfunction and pneumonia. Supportive nursing, nutritional support and physiotherapy are important. Mechanical ventilation is rarely available in resource poor countries to treat total paralysis. Drugs are needed to reducing the muscle spasms and rigidity, antibiotics to kill the bacteria and tetanus immunoglobulin to remove the toxins in the body. Diazepam has anticonvulsant, muscle relaxant, sedative and anxiety reducing effects. Diazepam treatment was associated with fewer deaths than was treatment with a combination of phenobarbitone and chlorpromazine. Combination treatments with diazepam did not give any further benefit (and may cause harm). The review authors searched the medical literature and identified two randomised controlled trials with a total of 134 hospitalized neonates and older children who had tetanus from Nigeria (19 neonates, seven children aged between one month and 10 years of age) and Indonesia (74 neonates, 34 children aged between three days and 12 years). All drugs were given orally as medications and feeds are usually given via nasogastric tube in the settings where the disease burden is high. Neither study provided information on the safety of the interventions or followed up survivors beyond discharge from hospital.

This record should be cited as: 
Okoromah CAN, Lesi AFE. Diazepam for treating tetanus. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003954. DOI: 10.1002/14651858.CD003954.pub2
Assessed as up to date: 
30 June 2004