Treatment for Tetanus Infected Wounds in Haiti

Experienced trauma surgeons are advising that all wounds in Haiti should be considered contaminated with Clostridium tetanus and will cause the patient to be at risk for clinical tetanus or lockjaw. They are recommending that the normal prophylaxis for tetanus will be inadequate and all patients will require passive immunization with tetanus immunoglobulin. To summarize the current regimen for treating grossly infected wounds:

tetanus immunoglobulin – 500 units IV

benzodiazepines if contractures occur – diazepam IV 10-40 mg q1-8 hours or the paralytics (if intubated) of vecuronium (IV drip) or pancuronium (IV intermittent)

antibiotics – metronidazole (Flagyl) is now the antibiotic of choice 500 mg q6 has replaced penicillin G

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3 Comments to “Treatment for Tetanus Infected Wounds in Haiti”

  1. Lombardo F Palma says:

    Although the use of the following protocol has not been approved or sanctined by any medical org., my use of the combiation: memantine 10 mg bid plus Allopurinol 300 mg bid for 60 days, was very gratifying in the reslution of a case of localized tetanus in a 39 Y/O Mexican man that had not received a DT booster in 15 yrs. He got tetanus from an injection given to his hip for relief of an unrelated ailment. The painful neuropathy resolved completly. LP

  2. Lombardo F Palma says:

    One way to prognosticate if a neurologic codition is NMDA mediated, is to perform an empirical drug challenge with a known antagonist and obseve for it’s effects on the condition’s signs & symptoms. I performed a dextromethorphan (DM) challenge on the patient descibed in my previous post. His pain diminished from 4/10 to 2/10 in 20 min and 1/10 in 30 min. DM challenge was done at 2.5 mg/kg in single oral dose. Upon this limited but valuable evidence, I followed the above protocol. LP

  3. Lombardo F Palma says:

    Another thougt in using appropriate technology in Haiti, NMDA blockade can also be accomplished with ketamine, a generic drug available in Haiti. It is a flexible drug that can also be given orally in OJ, blocking the NMDA channels and diminishing pain.LP

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