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Revista do Instituto de Medicina Tropical de São Paulo
Print version ISSN 0036-4665
LEVIN, Anna Sara Shafferman; BARONE, Antonio Alci and SHIROMA, Mario. Intrathecal antitoxin in the treatment of tetanus. Rev. Inst. Med. trop. S. Paulo [online]. 1987, vol.29, n.5, pp. 255-267. ISSN 0036-4665. http://dx.doi.org/10.1590/S0036-46651987000500001.
Tetanus is an important disease in underdeveloped countries. We present a review of literature concerning the use of intrathecal antitoxin in the treatment of tetanus. Historical aspects and the physiopathologic basis for this route of administration of antitoxin are brought up and the efficacy of the uses of heterologous and homologous antitoxin associated or not to systemic antitoxin and steroids is discussed. A great number of clinical studies have been done and many aren't well controlled or conclusive. Others have conflicting results. Homologous antitoxin (TIG) was used by GUPTA 14, in slight cases of tetanus; DIOP-MAR et al5, in Senegal; and LIST22, in Austria, with a reduction of the mortality by the disease when of its intrathecal use. However, BOLOT et al34, in France; SEDAGHATIAN35, and VALKI et al 44,45,46, don't obtain favorable results with intrathecal TIG. The same controversy arises with the use of intrathecal heterologous antitoxin (SAT). GALLAIS et al 10,11,12; SINGH et al38; KESWANI et al21; SANDERS et al32, obtain significantly better results when compared to their control groups, NEEQUAYE et al23; THOMAS et al43; and BHANDARI et al2, find no advantages to the use of this route. There are a number of factors possibly responsible for these differences in results: the intrathecal or systemic use of steroids; the use of homologous or heterologous antitoxin; their dosage and route of administration. The adverse effects due to intrathecal antitoxin are in general slight, however this route of administration should be considered experimental until there is further evidence of its benefit.
Keywords : Tétano [terapêutica]; Antitoxina tetânica [Administração intratecal]; Uso terapêutico [Administração e dosagem].