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October 23, 1991, Vol 266, No. 16 >
ARTICLE | October 23, 1991

Intrathecal Therapy in Tetanus: Title and subTitle BreakA Meta-analysis FREE

Elias Abrutyn, MD; Jesse A. Berlin, ScD
[+] Author Affiliations

Reprint requests to Veterans Affairs Medical Center, University and Woodland avenues, Philadelphia, PA 19104 (Dr Abrutyn).


JAMA. 1991;266(16):2262-2267. doi:10.1001/jama.1991.03470160094039
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Article
References

Objective.  —To assess the efficacy of intrathecal therapy with tetanus antibody (antitetanus equine serum or human tetanus immune globulin) in neonatal and adult tetanus using meta-analytical techniques.

Data Sources.  —Clinical trials identified by searching MEDLINE and by reviewing bibliographies of published articles.

Study Selection.  —Studies in English with concurrent controls treated without intrathecal therapy.

Data Extraction.  —Data were extracted by one author and verified by the second; conflicts were resolved by discussion.

Data Synthesis.  —No major treatment effect was found in neonatal tetanus when all studies were considered. A benefit was suggested for antitetanus equine serum in adult disease, but this finding should be accepted with caution. Subgroup analyses were limited in power. Methodological difficulties in neonatal and adult trials were common and safety has not been established.

Conclusions.  —Intrathecal therapy for tetanus with either antitetanus equine serum or human tetanus immune globulin is not of proven benefit and should only be given in the context of well-designed, controlled trials.(JAMA. 1991;266:2262-2267)

REFERENCES

1 +
Ildirim I.  A new treatment for neonatal tetanus: antitetanic serum and prednisolone given together intrathecally. Turk J Pediatr . 1967;;9:89-95.
2 +
Sedaghatian MR.  Intrathecal serotherapy in neonatal tetanus: a controlled trial. Arch Dis Child . 1979;;54:623-625.
3 +
Mbise RL, Mongi PS, Msengi AE, Amsi DM.  Tetanus neonatorum-experience with intrathecal serotherapy at Muhimbili Medical Center, Dar es Salaam. East Afr Med J . 1984;;61:892-895.
4 +
Mongi PS, Mbise RL, Msengi AE, Amsi DM.  Tetanus neonatorum: experience with intrathecal serotherapy at Muhimbili Medical Centre, Dar es Salaam , Tanzania. Ann Trop Paediatr . 1987;;7:27-31.
5 +
Bhandari B, Ajmera NK, Jagetiya PR.  Intrathecal anti-tetanus serum in management of tetanus neonatorum. Indian J Med Res . 1980;;72:685-687.
6 +
Singh AK, Bansal A, Goel SP, Agarwal VK.  Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus. Arch Dis Child . 1980;;55:527-531.
7 +
Neequaye J, Nkrumah FK.  Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus. Arch Dis Child . 1983;;58:276-278.
8 +
Paul SS, Utal DS, Jana AK, Mathew J.  Therapy in neonatal tetanus. Indian Pediatr . 1984;;21:689-694.
9 +
Gültekin A, Akarca MY, Oguz A, Gökalp A, Kanra G.  Double-blind trial of intramuscular and intramuscular plus intrathecal human tetanus immunoglobulin and intramuscular equine tetanus antitoxin in the treatment of tetanus neonatorum. Turk J Pediatr . 1988;;30:9-15.
10 +
Chugh K, Sehgal H.  Evaluation of intrathecal human tetanus immunoglobulins in tetanus neonatorum. Indian Pediatr . 1985;;22:153-158.
11 +
Sanders RKM, Joseph R, Martyn B, Peacock ML.  Intrathecal antitetanus serum (horse) in the treatment of tetanus. Lancet . 1977;;1:974-977.
12 +
Keswani NK, Singh AK, Upadhyanaya KD.  Intrathecal tetanus antitoxin in moderate and severe tetanus. J Indian Med Assoc . 1980;;75:67-69.
13 +
Vakil BJ, Armitage P, Clifford RE, Lawrence DR.  Therapeutic trial of intracisternal human tetanus immunoglobulin in clinical tetanus. Trans R Soc Trop Med Hyg . 1979;;73:579-583.
14 +
Gupta PS, Kapoor R.  Intrathecal use of human tetanus immunoglobulin. Clinician . 1980;;44:127-133.
15 +
Gupta PS, Kapoor R, Goyal S, Batra VK, Jain BK.  Intrathecal human tetanus immunoglobulin in early tetanus. Lancet . 1980;;2:439-440.
16 +
Khan AA, Maguire MJ, Patel YS.  Intra-thecal antitetanus serum in the management of tetanus neonatorum. Med J Zambia . 1978;;12:121-122.
17 +
Yong FY.  Treatment of tetanus neonatorum in a rural setting. Med J Malaysia . 1983;;38:74-76.
18 +
Chopra K, Kumar P, Gupta A.  Intrathecal human tetanus hyperimmunoglobulin in neonatal tetanus. Indian Pediatr . 1988;;25:530-533.
19 +
Chopra K, Gupta A, Mhatre K.  Intrathecal tetanus hyperimmune human gamma globulin in the treatment of tetanus. Indian Pediatr . 1986;;23:775-778.
20 +
Onuora CA, Sambo-Donga L, Yahaya H.  Intrathecal antitetanus serum in the management of tetanus. East Afr Med J . 1982;;59:52-55.
21 +
Thomas PP, Crowell EB, Mathew M.  Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus. Trans R Soc Trop Med Hyg . 1982;;76:620-623.
22 +
Mar ID, Badiane S, Ba A.  Traitement du tétanos par le sérum antitétanique hétérologue intrathécal. Bull Soc Med Afr Noire Lgne Frse . 1978;;23:393-401.
23 +
Ildirim I.  Intrathecal serotherapy of tetanus. Turk J Pediatr . 1974;;16:103-110.
24 +
Singh G, Goyal BB, Singh DP.  Role of intrathecal tetanus antitoxin (equine) in tetanus neonatorum. J Indian Med Assoc . 1989;;87:8-10.
25 +
Ogatuti P.  Treatment of tetanus by lumbar intrathecal tetanus-antitoxin.  P N G Med J . 1980;;23:179-181.
26 +
World Health Organization. Expanded programme on immunization: progress and evaluation report by the Director General. Presented at the 39th World Health Assembly; 1986.
27 +
Sutter RW, Cochi SL, Brink EW, Sirotkin BI.  Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984. Am J Epidemiol . 1990;;131:132-142.
28 +
DerSimonian R, Laird N.  Meta-analysis in clinical trials. Controlled Clin Trials . 1986;;7:177-188.
29 +
Light RJ, Pillemer DR. Summing Up . Cambridge, Mass: Harvard University Press; 1984;.
30 +
Patel JC, Joag GG.  Grading of tetanus to evaluate prognosis. Indian J Med Sci . 1959;;13:834-840.
31 +
Hendrickse RG, ed. Paediatrics in the Tropics: Current Review . New York, NY: Oxford University Press Inc; 1981;.
32 +
Begg CB, Berlin JA.  Publication bias and the dissemination of clinical research. J Natl Cancer Inst . 1989;;81:107-115.
33 +
Beague RE, Lindo-Soriano I.  Failure of intrathecal tetanus antitoxin in the treatment of tetanus neonatorium. J Infect Dis . 1991;;164:419-420.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Ildirim I.  A new treatment for neonatal tetanus: antitetanic serum and prednisolone given together intrathecally. Turk J Pediatr . 1967;;9:89-95.
2 +
Sedaghatian MR.  Intrathecal serotherapy in neonatal tetanus: a controlled trial. Arch Dis Child . 1979;;54:623-625.
3 +
Mbise RL, Mongi PS, Msengi AE, Amsi DM.  Tetanus neonatorum-experience with intrathecal serotherapy at Muhimbili Medical Center, Dar es Salaam. East Afr Med J . 1984;;61:892-895.
4 +
Mongi PS, Mbise RL, Msengi AE, Amsi DM.  Tetanus neonatorum: experience with intrathecal serotherapy at Muhimbili Medical Centre, Dar es Salaam , Tanzania. Ann Trop Paediatr . 1987;;7:27-31.
5 +
Bhandari B, Ajmera NK, Jagetiya PR.  Intrathecal anti-tetanus serum in management of tetanus neonatorum. Indian J Med Res . 1980;;72:685-687.
6 +
Singh AK, Bansal A, Goel SP, Agarwal VK.  Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus. Arch Dis Child . 1980;;55:527-531.
7 +
Neequaye J, Nkrumah FK.  Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus. Arch Dis Child . 1983;;58:276-278.
8 +
Paul SS, Utal DS, Jana AK, Mathew J.  Therapy in neonatal tetanus. Indian Pediatr . 1984;;21:689-694.
9 +
Gültekin A, Akarca MY, Oguz A, Gökalp A, Kanra G.  Double-blind trial of intramuscular and intramuscular plus intrathecal human tetanus immunoglobulin and intramuscular equine tetanus antitoxin in the treatment of tetanus neonatorum. Turk J Pediatr . 1988;;30:9-15.
10 +
Chugh K, Sehgal H.  Evaluation of intrathecal human tetanus immunoglobulins in tetanus neonatorum. Indian Pediatr . 1985;;22:153-158.
11 +
Sanders RKM, Joseph R, Martyn B, Peacock ML.  Intrathecal antitetanus serum (horse) in the treatment of tetanus. Lancet . 1977;;1:974-977.
12 +
Keswani NK, Singh AK, Upadhyanaya KD.  Intrathecal tetanus antitoxin in moderate and severe tetanus. J Indian Med Assoc . 1980;;75:67-69.
13 +
Vakil BJ, Armitage P, Clifford RE, Lawrence DR.  Therapeutic trial of intracisternal human tetanus immunoglobulin in clinical tetanus. Trans R Soc Trop Med Hyg . 1979;;73:579-583.
14 +
Gupta PS, Kapoor R.  Intrathecal use of human tetanus immunoglobulin. Clinician . 1980;;44:127-133.
15 +
Gupta PS, Kapoor R, Goyal S, Batra VK, Jain BK.  Intrathecal human tetanus immunoglobulin in early tetanus. Lancet . 1980;;2:439-440.
16 +
Khan AA, Maguire MJ, Patel YS.  Intra-thecal antitetanus serum in the management of tetanus neonatorum. Med J Zambia . 1978;;12:121-122.
17 +
Yong FY.  Treatment of tetanus neonatorum in a rural setting. Med J Malaysia . 1983;;38:74-76.
18 +
Chopra K, Kumar P, Gupta A.  Intrathecal human tetanus hyperimmunoglobulin in neonatal tetanus. Indian Pediatr . 1988;;25:530-533.
19 +
Chopra K, Gupta A, Mhatre K.  Intrathecal tetanus hyperimmune human gamma globulin in the treatment of tetanus. Indian Pediatr . 1986;;23:775-778.
20 +
Onuora CA, Sambo-Donga L, Yahaya H.  Intrathecal antitetanus serum in the management of tetanus. East Afr Med J . 1982;;59:52-55.
21 +
Thomas PP, Crowell EB, Mathew M.  Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus. Trans R Soc Trop Med Hyg . 1982;;76:620-623.
22 +
Mar ID, Badiane S, Ba A.  Traitement du tétanos par le sérum antitétanique hétérologue intrathécal. Bull Soc Med Afr Noire Lgne Frse . 1978;;23:393-401.
23 +
Ildirim I.  Intrathecal serotherapy of tetanus. Turk J Pediatr . 1974;;16:103-110.
24 +
Singh G, Goyal BB, Singh DP.  Role of intrathecal tetanus antitoxin (equine) in tetanus neonatorum. J Indian Med Assoc . 1989;;87:8-10.
25 +
Ogatuti P.  Treatment of tetanus by lumbar intrathecal tetanus-antitoxin.  P N G Med J . 1980;;23:179-181.
26 +
World Health Organization. Expanded programme on immunization: progress and evaluation report by the Director General. Presented at the 39th World Health Assembly; 1986.
27 +
Sutter RW, Cochi SL, Brink EW, Sirotkin BI.  Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984. Am J Epidemiol . 1990;;131:132-142.
28 +
DerSimonian R, Laird N.  Meta-analysis in clinical trials. Controlled Clin Trials . 1986;;7:177-188.
29 +
Light RJ, Pillemer DR. Summing Up . Cambridge, Mass: Harvard University Press; 1984;.
30 +
Patel JC, Joag GG.  Grading of tetanus to evaluate prognosis. Indian J Med Sci . 1959;;13:834-840.
31 +
Hendrickse RG, ed. Paediatrics in the Tropics: Current Review . New York, NY: Oxford University Press Inc; 1981;.
32 +
Begg CB, Berlin JA.  Publication bias and the dissemination of clinical research. J Natl Cancer Inst . 1989;;81:107-115.
33 +
Beague RE, Lindo-Soriano I.  Failure of intrathecal tetanus antitoxin in the treatment of tetanus neonatorium. J Infect Dis . 1991;;164:419-420.

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