TREATMENT OF TETANUS WITH SPECIAL REFERENCE TO BETAMETHASONE

192 consecutive patients with established (non-neonatal) tetanus were treated conservatively in one year with betamethasone, ATA and sedation with a mortality rate of 37%. 170 consecutive patients in the previous year, who were not given betamethasone, had a mortality of 61%. Highly significant results have been obtained among cases of comparably very high inherent mortality. The definition of high mortality is explained. Optimal results were obtained by giving betamethasone intravenously. More than 24 mg. daily to adults has been shown to be of little advantage, but more than 40 mg. may be profitably given intramuscularly to children. The use of oral betamethasone is contra-indicated in severe tetanus. A very high human tolerance of betamethasone has been demonstrated despite the possibility of non-gastric haemorrhage. The mode of action of betamethasone in tetanus is discussed, relating to possible anti-histamine, anti-cholinergic and anti-toxic effects. Betamethasone has been shown greatly to facilitate the conservative management of tetanus, quite apart from considerably lowering the mortality. © 1969 Royal Society of Tropical Medicine and Hygiene.