is a major cause of infant mortality in underdeveloped countries.Pregnant women who are not immunized against tetanus don't pass on protective antibodies to their babies.
Infection causes
- Unhygienic birth practices
- Biblical cord in contaminated at the time of cutting after delivery
Worldwide risk factors for neonatal tetanus include the following:
- Unvaccinated mother, home delivery, and unhygienic cutting of the umbilical cord increase susceptibility to tetanus
- A history of neonatal tetanus in a previous child is a risk factor for subsequent neonatal tetanus
- Potentially infectious substances applied to the umbilical stump (Eg, animal dung, mud, or clarified butter) are risk factors for neonates
Signs and symptoms
Usually appears by the third days after birth rarely after the age of two weeks
- Excessive crying
- Refused to feed
- Paralysis or may develops
- Opisthotonic posturing and experience painful spasm
- The mouth in kept slightly open due to pull and spasm of the neck
- Pharyngeal masules go into spasm and cause dysphasia and choking
- Lock jaw or reflex trismus followed by spasm of limbs
- Apnes (dalyed in breathing)
- cynosis
Treatment
- Airway maintenance (ICU=Intensive care unit)
- Isolate
- Incubation and mechanical ventilation if needed
- Human tetanus immunoglobulin :I/M 500-1000 IU
Antibiotics
- Crystalline penicillin
- Metronidazole
Dosing & Uses
Pediatric
Dosing Forms & Strengths
Neonatal (<28 Days) Anaerobic Infection
<7 days
- 1.2-2 kg: 7.5 mg/kg IV/PO qDay
- >2 kg: 15 mg/kg/day IV/PO divided q12hr
>7 days
- 1.2-2 kg: 15 mg/kg/day IV/PO divided q12hr
- >2 kg: 30 mg/kg/day IV/PO divided q12hr
Infants and Children
- 30 mg/kg/day PO/IV divided q6hr; not to exceed 4 g/day
Clostridium Difficile Colitis
Trichomoniasis
Helicobacter Pylori-Associated Peptic Ulcer Disease (Off-label)
Dosing & Uses
Adult
Dosing Forms & Strengths
Anaerobic Bacterial Infections
Maintenance dose: 7.5 mg/kg PO/IV (over 1 h) q6hr x 7-10 days (or 2-3 weeks if severe)
Sexually Transmitted Disease
Prevention following sexual assault
2 g PO as a single dose; 3-drug regimen that also includes ceftriaxone or cefixime, PLUS azithromycin or doxycycline (CDC STD guidelines, 2010)
Bacterial Vaginosis
Nonpregnant women
- 500 mg PO BID x 7 days, OR
- 2 g PO qDay single dose, OR
- Extended-release: 750 mg PO qDay x 7 days
Pregnant women
- 500 mg PO BID x 7 days, OR
- 250 mg PO TID x 7 days
Colorectal Surgical Infection
Prophylaxis; start after mechanical bowel preparation the afternoon and evening before surgery
1 g PO q6-8hr for 3 doses
15 mg/kg IV over 30-60 min; complete approximately 1 hr before surgery; may administer 7.5 mg/kg IV over 30-60 min at 6 and 12 hr after initial dose for maintenance; discontinue within 12 hr after surgery
Trichomoniasis
250 mg PO q8hr for 7 days; alternatively, 375 mg PO q12hr for 7 days
2 g PO qDay single dose; alternatively, 1g PO q12hr for 2 doses
Amebiasis
500-750 mg PO q8hr for 5-10 days
Giardiasis (Off-label)
500 mg PO q12hr for 5-7 days
Gardnerella Infection
Immediate release: 500 mg PO q12hr
Extended-release: 750 mg PO qDay for 7 days; take on empty stomach
Helicobacter Pylori Infection (Off-label)
250-500 mg PO QID in combination with tetracycline (500 mg) and bismuth subsalicylate (525 mg) x 14 days
Nongonococcal Urethritis (Off-label)
2 g PO qDay single dose with erythromycin (500 mg QID) or erythromycin ethylsuccinate (800 mg QID) x 7 days
Pelvic Inflammatory Disease (Off-label)
500 mg PO q12hr for 14 days in conjunction with ofloxacin or levofloxacin
Maintenance oxygen and Refer to higher center
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