Vitamin C for preventing and treating tetanus

Hemilä H, Koivula T

Published Online:

October 5, 2011

Tetanus is a disease caused by tetanus toxin, which is produced by the bacterium Clostridium tetani. This bacterium typically infects penetrating wounds contaminated by foreign material such as soil. In developing countries, poor hygiene after childbirth may cause tetanus in newborn babies. Even though vaccination has dramatically decreased the burden of tetanus, there are still hundreds of thousands of cases per year globally. We found one controlled trial that examined whether one gram per day of intravenous vitamin C would help in the treatment of tetanus patients. Vitamin C was used alongside standard treatments for tetanus. Intravenous vitamin C reduced the mortality of children aged between 1 and 12 with tetanus by 100% and that of 13 to 30 year old patients by 45%. The trial was not properly conducted and caution is required in the interpretation of the findings. Vitamin C cannot be recommended as a treatment for tetanus on the basis of this single study. Further investigation of the role of vitamin C in tetanus treatment is warranted.

Abstract (click to read)

Background:

Tetanus is a severe disease that can be prevented by vaccination. In developing countries vaccination coverage is not always high, and cases still occur in developed countries, particularly in elderly people owing to their reduced immuno protection. There are hundreds of thousands of tetanus cases per year globally. In animal studies, vitamin C has protected against various infections. In a study with rats, vitamin C protected against the purified tetanus toxin.

Objectives:

To assess the prophylactic and therapeutic effect of vitamin C on tetanus.

Search strategy:

We searched the Cochrane Wounds Group Specialised Register (searched 4 August 2011); Cochrane Infectious Diseases Group Specialised Register (Searched 24 August 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to August Week 2 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 18, 2011); and Ovid EMBASE (2009 to 2010 Week 50) and the reference lists of relevant reviews and monographs.

Selection criteria:

Controlled trials of vitamin C as a prevention or treatment for tetanus, whether or not these were placebo controlled, in any language, published or unpublished. Two authors independently made inclusion decisions.

Data collection and analysis:

Both review authors independently extracted data from trial reports and assessed methodological quality. We calculated the relative risk of death by using the RevMan computer program and odds ratio by using the StatXact computer program.

Main results:

One single trial was eligible for inclusion. This non-randomised, controlled, unblinded trial undertaken in Bangladesh involved 117 tetanus patients. Vitamin C at a dosage of 1 g/day was administered intravenously alongside conventional treatment. At recruitment, the participants were stratified into two age groups and the results were reported by age. In the children aged 1 to 12 years (n = 62), vitamin C treatment was associated with a 100% reduction in tetanus mortality (95% CI from -100% to -94%). In people aged 13 to 30 years (n = 55), vitamin C treatment was associated with a 45% reduction in tetanus mortality (95% CI from -69% to -5%).

Authors' conclusions:

A single, non-randomised, poorly reported trial of vitamin C as a treatment for tetanus suggests a considerable reduction in mortality. However, concerns about trial quality mean that this result must be interpreted with caution and that vitamin C cannot be recommended as a treatment for tetanus on the basis of this evidence. New trials should be carried out to examine the effect of vitamin C on tetanus treatment.

This record should be cited as:

Hemilä H, Koivula T. Vitamin C for preventing and treating tetanus. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006665. DOI: 10.1002/14651858.CD006665.pub2

Assessed as up to date:

August 26, 2011

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Primary Review Group:

Wounds Group

Health topics:

Complementary & alternative medicine > Infectious disease > Tetanus

Infectious disease > Tetanus

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Vitamin C for preventing and treating tetanus

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