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A first-of-its kind randomised controlled trial compared two different antitoxin treatments for tetanus. A comparison of human and equine intramuscular antitoxin in adults found that intramuscular equine antitoxin is safe and effective for treating tetanus in adults. Addition of additional intrathecal (spinal) antitoxin does not add any benefit compared to treatment with intramuscular antitoxin alone.

Dr Lam Minh Yen, Senior Study Doctor at OUCRU, leads a workshop for adult patients recovering tetanus. Tetanus has been one of the components of OUCRU-HTD research programme for over 20 years.
Dr Lam Minh Yen, Senior Study Doctor at OUCRU, leads a workshop for adult patients recovering tetanus. Tetanus has been one of the components of OUCRU-HTD research programme for over 20 years.

This joint study carried out by the Oxford University Clinical Research Unit (OUCRU) and the Hospital for Tropical Diseases in Ho Chi Minh City has important implications for the treatment of tetanus, especially in low-resource settings.

Intramuscular antitoxin is recommended for the treatment of tetanus. The study found no evidence of increased adverse events in those treated with equine antitoxin compared to human antitoxin.

Equine antitoxin is cheaper and, in many countries, more easily available than human antitoxin. This study’s findings have shown that intramuscular equine antitoxin is safe, particularly where human antitoxin is unavailable.

Tetanus toxin acts within the central nervous system, where there is limited penetration of peripherally administered antitoxin; thus, intrathecal (spinal) antitoxin administration was thought to improve clinical outcomes compared with intramuscular injection. The study found that intrathecal injection, an invasive procedure, did not substantially reduce the requirement for mechanical ventilation in adults with tetanus.

“The results of this study affirm that the treatments for tetanus, using intramuscular equine antitoxin, which is a minimally-invasive treatment, is safe and effective. Compared to the invasive, complicated procedure of intrathecal injection, the result of this study shows the potential of intramuscular equine antitoxin in low and middle-income settings,” wrote Dr Lam Minh Yen, Senior Study Doctor at OUCRU and Dr Nguyen Van Hao, first author, Head of the Adult Intensive Care Unit at the Hospital for Tropical Diseases, Ho Chi Minh City, and Head of the Infectious Disease Department at the University of Medicine and Pharmacy, Ho Chi Minh City.

Read the full story on the OUCRU website.

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