Intrathechal vs. Intramuscular Human Tetanus Immunoglobulin in Pediatric Tetanus: A Retrospective Study
Objective To evaluate the effect of intrathecal vs.
intramuscular tetanus immunoglobulin therapy on hospital stay and mortality in
pediatric tetanus patients admitted to a tertiary care hospital.
Methods Retrospective analysis of hospital records of
tetanus cases to the pediatric ward during two year period from march
2012 to february 2014 was done.
All patients were managed as per pre-existing unit protocol. Group A received Human tetanus immunoglobulin
(TIG) 250 unit via the Intrathecal route preceded by IV ketamine (1 mg/kg) for
proper relaxation to ease the procedure and the group B was given TIG 750 unit
via intramuscular route. Whether to give TIG by Intrathecal or intramuscular
route was decided according to the treating unit’s protocol. Information
regarding– sex, age, immunization status, mode of infection, grade of tetanus,
outcome and hospital stay was recorded in the two groups.
Results After excluding Neonatal tetanus cases there were 40
patients aged between 1 to 12 years during the two year study period. Out of
40, group A had 15 patients (intrathecal route) and group B had 25
(intramuscular route). Mortality and hospital stay was found to be numerically less,
but statistically not significant, in group A (26.67%; 12.4 ±2.25days) as
compared to group B (28%:15.4 ± 1.69 days).
Conclusion We found no significant difference between intrathecal
immunoglobulin and intramuscular immunoglobulin therapy in management of pediatric
tetanus in terms of mortality and hospital stay. An unintended result was that ketamine can be safely used as a sedative in tetanus patients for lumbar puncture to give intrathecal antitetanus immunoglobulin.
