Emerging treatments
OnabotulinumtoxinA
Botulinum toxin acts on lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. It may have a role in reducing muscle rigidity and spasms in tetanus; it has been used in a very small number of patients to treat, for example, trismus, by injection into the masseter and temporalis muscles. Its use in tetanus has not yet been evaluated in a clinical trial.[81]
Intrathecal tetanus antitoxin
A randomized controlled trial in Vietnam on intrathecal tetanus antitoxin in the treatment of adults with tetanus concluded that intrathecal antitoxin administration was safe but did not provide overall benefit in addition to intramuscular administration of antitoxin. The study also found no advantage of intramuscular human antitoxin over intramuscular equine antitoxin.[82]
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