_Trismus or lockjaw (inability to open the mouth)
_Opisthotonos (rigid arching of the back muscles).
_Risus sardonicus (sustained spasm of the facial muscles)
_Two I.M or S.C injections of 0.5ml given 1 month apart. Booster dose: Every 10yrs.
_Full immunization schedule
_For effective immunization a person needs to receive 3 doses of diphtheria/tetanus/pertussis vaccine in infancy then TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood
_For more details refer to the immunization schedule under Pharmacology & Pharmatherapeutics
_Im Tetanus immunoglobulin 1,000 to 3,000 units STAT
_IV or oral Metronidazole 2gm/day x 7-10 days (currently the drug of choice)
_IV Penicillin G ; Adults -1 mega unit QID x 10/7. Children-50,000 IU/kg QID but BD for infants
(Penicillin G is structurally similar to GABA and competitively antagonises this neurotransmitter hence potentiating the effect of neurotoxin)
_Other antibiotics that can be include: Tetracyclines, macrolides, clindamycin, cephalosporins and chloramphenicol are also effective.
_IV / oral Diazepam 10 – 60mg QID (at 0, 6, 12, 18 and 24hr) and
_IV/IM Phenobarbitone 30-90mg BD (at 0 and 24hr) and
_IM Chlorpromazine 100mg alternation with diazepam (i.e. 3, 9, 15 and 21hr)
_Magnesium sulphate (alone or in combination with benzodiazepines): 5 gm (or 75mg/kg) IV loading dose, then 2–3 g/hr until spasm control is achieved.
_Adequate fluids and nutrition