Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial

Kumar, Avg, Kothari, VM, Krishnan, A and Karnad, DR (2004) Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial. Annals of Tropical Medicine and Parasitology, 98 1: 59-63. doi:10.1179/000349804225003037


Author Kumar, Avg
Kothari, VM
Krishnan, A
Karnad, DR
Title Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial
Journal name Annals of Tropical Medicine and Parasitology   Check publisher's open access policy
ISSN 0003-4983
1364-8594
Publication date 2004-01-01
Sub-type Article (original research)
DOI 10.1179/000349804225003037
Volume 98
Issue 1
Start page 59
End page 63
Total pages 5
Place of publication Hanover Walk, Leeds, W. Yorks, U.K.
Publisher Maney Publishing
Language eng
Formatted abstract
Penicillin, the drug of choice in tetanus, may potentiate the effect of tetanus toxin by inhibiting the type-A (GABAA) receptor for γ-amino-n-butyric acid. Metronidazole has therefore been suggested as an alternative. Intramuscular benzathine penicillin (1.2 million units as a single dose; N = 56), enteral metronidazole (600 mg every 6 h for 10 days; N = 55) and intravenous benzyl penicillin (2 million units every 4 h for 10 days; N = 50) were therefore compared, in a randomized, controlled trial, among patients with all grades of tetanus. On presentation, the three treatment groups were similar in terms of age and sex distributions, immune statuses, durations of illness, and their APACHE-II scores and Ablett's grades of tetanus. Of the patients given benzathine penicillin, 36 required tracheostomy, 10 neuromuscular blockade, and 23 mechanical ventilation; the corresponding numbers for the metronidazole (34, 12 and 18, respectively) and benzyl-penicillin groups (39, 12 and 25, respectively) were similar (P > 0.10). The incidences of dysautonomia and nosocomial pneumonia and the numbers of in-hospital deaths (26 with benzathine penicillin, 19 with metronidazole and 22 with benzyl penicillin; P = 0.392) were also similar in each treatment arm. The length of the hospital stay was longer in the patients receiving benzyl penicillin than in the benzathine-penicillin or metronidazole groups, with means (S.D.) of 21.9 (15), 16.9 (11) and 19.9 (15) days, respectively, but the difference was not statistically significant (P = 0.09). Although the three antibiotic regimens investigated appear equally effective, benzathine penicillin offers the convenience of a single, intramuscular injection instead of the 10 days of therapy needed with the other two drugs.
© 2004 The Liverpool School of Tropical Medicine
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Sat, 09 Apr 2011, 01:34:03 EST by Dr Anand Krishnan on behalf of Anaesthesiology and Critical Care - PAH