Question 2
The following lines of treatment are indicated except:

Answer
The incorrect answer is DPT vaccination.

The amount of toxin circulating in natural disease is insufficient to provoke an immunizing antibody response, so all patients should receive a course of tetanus toxoid to prevent recurrences. This is given as Td. In children over 10 years old DPT is not recommended because the pertussis component may cause a strong inflammatory response, particularly in Nepal, where only whole cell pertussis vaccine is available.

Once tetanus toxin has bound to its receptors in the central nervous system the effect cannot be reversed by any pharmacological manoeuver. Therapy is essentially supportive.

A penicillin antibiotic is given to prevent further growth and toxin production by Clostridium tetani and additional antibiotics should be given according to the patient’s clinical condition. More recent studies have shown that IV metronidazole should be used for the treatment of established cases of tetanus. If available, human tetanus immune globulin (HTIG) should be given in order to neutralize any unbound toxin.

A few hours after administering the antitoxin and antibiotic any wound should be cleaned and debrided. Earlier debridement may cause new toxin to be released into the patient's blood stream.