Aim: To evaluate the effect of intrathecal vs. intramuscular tetanus immunoglobulin therapy on hospital stay and mortality in pediatric tetanus patients admitted to a tertiary care hospital. Methods and Material: Retrospective analysis of hospital records of tetanus cases to the pediatric ward during two year period between 2012 and 2014 was done. All patients were managed as per preexisting unit protocol. Group A received Human tetanus immunoglobulin (TIG) 250 unit a via the Intrathecal route preceded by IV ketamine (1 mg/kg) for proper relaxation to ease the procedure and the group B was given TIG 750 unit via intramuscular route. Whether to give TIG by Intrathecal or intramuscular route was decided according to the treating unit’s protocol. Information regarding sex, age, immunization status, mode of infection, grade of tetanus, outcome and hospital stay was recorded in the two groups. Statistical Analysis: Fisher’s exact test, Chi square test, Unpaired t test. Results: There were total 40 patients with tetanus aged between 1 to 12 years during the two year study period. Neonatal tetanus cases were excluded. Out of 40, 15 patients were included in group A (intrathecal route) and 25 in group B (intramuscular route). Mortality and hospital stay was found to be less in group A (26.67%; 12.4 ±2.25days) as compared to group B (28%:15.4 ± 1.69 days). Conclusion: We found no significant difference between intrathecal immunoglobulin and intramuscular immunoglobulin therapy in management of pediatric tetanus in terms of mortality and hospital stay.
Keywords: Tetanus; Immunoglobulin; Intrathecal.
: Jayendra R. Gohil, Professor, Department of Pediatrics, Govt. Medical College, Sir T. Hospital, Bhavnagar364002, Gujarat, India.