Tetanus: The Daily PANCE Blueprint
A 45-year-old man presents to the emergency department with muscle stiffness and painful spasms. He sustained a puncture wound to his foot from a rusty nail five days ago but did not seek medical attention at that time. Physical examination reveals trismus (lockjaw), risus sardonicus (sardonic smile), and generalized muscle rigidity. His immunization history is unknown. In addition to providing supportive care and administering tetanus immune globulin, which of the following antibiotics is the most appropriate to treat his condition?
A. Metronidazole
B. Penicillin G
C. Azithromycin
D. Ciprofloxacin
E. Fluconazole
Answer and topic summary
The answer is A. Metronidazole
Metronidazole is the antibiotic of choice for treating tetanus caused by Clostridium tetani. It is effective against anaerobic bacteria and helps eradicate the vegetative forms of the bacterium, thereby preventing further toxin production. Metronidazole is preferred over penicillin G because penicillin can act as a GABA antagonist, potentially exacerbating the muscle spasms and seizures associated with tetanus.
Management of tetanus includes:
- Neutralization of unbound toxin: Administration of human tetanus immune globulin (HTIG).
- Eradication of the organism: Antibiotic therapy with metronidazole.
- Control of muscle spasms: Use of benzodiazepines like diazepam.
- Supportive care: Airway management and monitoring in an intensive care unit if necessary.
- Immunization: Initiation of the tetanus vaccination series, as infection does not confer immunity.
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Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ ⇒
