Failure of Intrathecal Tetanus Antitoxin in the Treatment of Tetanus Neonatorum

Neonatal tetanus is the second leading cause of vaccine-preventable deaths in the world. Nineteen patients were included in each group. Overall mortality was 17 (45%) of 38 cases. Mortality was higher in the group that received in intrathecal antitoxin (58% vs. 32%), but this did not achieve statistical significance. Contradictory results have been obtained in different studies assessing the use of intrathecal tetanus antitoxin in the treatment of neonatal tetanus. Our study fails to demonstrate a beneficial effect; however, there was also no detrimental effect. The less favorable outcome of the treatment group may be explained by increased severity of disease. During a 12-month period, we randomly assigned patients admitted to the infectious disease ward at the Instituto Nacional de Salud del Nino of Lima, Peru with the diagnosis of neonatal tetanus to receive either the standard management (penicillin G, 10,000 IU of intravenous ATS, sedation and surgical cleaning) or the standard treatment plus a single intrathecal dose of 100 IU of ATS and 2 mg of dexamethasone.