<b>General measures</b><br>ffIf at HC2 or 3, refer to hospital ffNurse patient intensively in a quiet isolated area ffMaintain close observation and attention to airway, temperature, and spasms ffInsert nasogastric tube (NGT) for nutrition, hydration, and medicine administration ffOxygen therapy if needed ffPrevent aspiration of fluid into the lungs ffAvoid IM injections as much as possible; use alternative routes (e.g. NGT, rectal) where possible ffMaintain adequate nutrition as spasms result in hugh metabolic demands ffTreat respiratory failure in ICU with ventilation}<b>Neutralise toxin</b><br>ffGive tetanus immunoglobulin human (TIG) –– 150 IU/kg (adults and children). Give the dose in at least 2 different sites IM, different from the tetanus toxoid site ffIn addition, administer full course of ageappropriate TT vaccine (TT or DPT) – starting immediately}<b>Treatment to eliminate source of toxin</b><br>ffClean wounds and remove necrotic tissue.<br><b>First line antibiotics</b><br>ffMetronidazole 500 mg every 8 hours IV or by mouth for 7 days Child: 7.5 mg/kg every 8 hours<br><b>Second line antibiotics</b><br>ffBenzylpenicillin 2.5 MU every 6 hours for 10 days Child: 50,000-100,000 IU/kg per dose}<b>Control muscle spasms</b><br><b> First line</b><br>ffDiazepam 10 mg (IV or rectal) every 1 to 4 hours ffChild: 0.2 mg/kg IV or 0.5 mg/kg rectal (maximum of 10 mg) every 1 to 4 hours}<b>Other agents</b><br>ffMagnesium sulphate (alone or with diazepam): 5 g (or 75 mg/kg) IV loading dose then 2 g/hour till spasm control is achieved –– Monitor knee-jerk reflex, stop infusion if absent ffOr chlorpromazine (alone or alternate with diazepam) 50-100 mg IM every 4-8 hours Child: 4-12 mg IM every 4-8 hours or ff12.5 mg-25 mg by NGT every 4-6 hours –– Continue for as long as spasms/rigidity lasts}<b>Control pain</b><br>ffMorphine 2.5-10 mg IV every 4-6 hours (monitor for respiratory depression) Child: 0.1 mg/kg per dose<br>ffParacetamol 1 g every 8 hours Child: 10 mg/kg every 6 hours