Successful
management of severe generalized tetanus in a 23-year man with
Phenobarbital adjuvant: a case report
Arezoo Ahmadi1, Elahe
Karimpour-Razkenari2, Ramin Ansari2,
Mahforouzalsadat Marashi3, Hamidreza
Sharifnia1, Atabak Najafi1,
Mojtaba
Mojtahedzadeh2*
1 Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran
2 Department of Anesthesiology and Critical Care, School of Medicine,
Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
3 Department of Infectious Disease and Tropical Medicine, School of
Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran,
Iran.
Corresponding author: Mojtaba Mojtahedzadeh; Pharmacist; Board Certified
of Pharmacotherapy Specialty; Fellowship of Critical Care
Pharmacotherapy; Department of Clinical Pharmacy, Tehran University of
Medical Sciences
mojtahed@tums.ac.ir
Sina Hospital, Imam Khomeini St, Hasanabad Square, Tehran, Iran
Tel: +982164120
Postal code: 1136746911
Fax number: 00982166348587
Abstract
With a mortality rate of up to 50%, generalized tetanus is still a
global concern, especially in low and middle-income countries. A
23-year-old man from Afghanistan was admitted to Sina Hospital,
affiliated with Tehran University of Medical Sciences, with the chief
complaint of generalized severe spasms and lockjaw. The patient had a
history of skin lesions and had never been vaccinated against tetanus.
He admitted to the intensive care unit after intubation in emergency
room, with diagnose of severe generalized tetanus. After receiving
tetanus immunoglobulin and intravenous metronidazole, a combination
therapy of midazolam, propofol, atracurium and morphine was
administered. Due to the refractory muscular spasms intravenous
phenobarbital started and little by little recovery was achieved. With
no symptom recurrence, after receiving the first 2 doses of the Td
vaccine, the patient was discharged on day 42.
Keywords: Tetanus, phenobarbital, Intensive care