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Management of Clinical Tetanus

Stephen N. Cohen, MD
JAMA. 1968;206(2):375. doi:10.1001/jama.1968.03150020091025.
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To the Editor:—  The article "Tetanus" (204:614, 1968) contains statements and recommendations which should be challenged.First, the author has confused aluminum phosphate adsorbed toxoid with alum toxoid. These materials have similar uses but are not identical.Second, a recommendation that oxytetracycline be administered to patients as prophylaxis against possible tetanus in the place of antitoxin of animal origin (if human hyperimmune globulin is not available) is not justifiable. Tetracycline-resistant clostridia have been reported, and certainly tetracycline could not be relied upon to penetrate into poorly vascularized areas likely to harbor the development of Clostridium tetani. Penicillin, which might penetrate because of the higher levels which can be safely attained is the antibiotic of choice for the eradication of clostridia, but if the patient needs antitoxin, antibiotics are no suitable substitute.Third, the daily administration of equine or bovine antitoxin may perhaps increase the incidence or severity of serum sickness


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