Adjunctive Use of Ceftriaxone and Sodium Valproate in the Management of Tetanus: A Case Report and Literature Review

Abstract

Since the introduction of active immunisation against tetanus in 1923, there has been a dramatic decline in cases of tetanus all over the world. However, cases of tetanus are still being reported in developing and developed economies; with more cases reported from Africa than from Europe. The three planks in the management of tetanus are the elimination of toxin production, neutralisation of unbound toxin and control of spasms. In this report of a fifteen-year old Nigerian female patient with Ablett II tetanus, elimination of toxin production was by the combination of metronidazole and the glutamate transporter I (GLT I) enhancer, ceftriaxone. Neutralisation of unbound toxin was by the use of anti-tetanus serum due to the non-availability of human tetanus immune globulin. Control of spasms was mainly by the use of the GABAergic-enhancing drugs diazepam and sodium valproate combined with the use of the anti-excitotoxics magnesium sulphate and ketamine. The introduction of valproate hastened the disappearance of opisthotonus and residual rigidity and deserves to be added to drug combination regimens for tetanus.

Keywords: tetanus, ceftriaxone, diazepam, sodium valproate, magnesium sulphate, ketamine