Intrathecal therapy in tetanus. A meta-analysis
E. Abrutyn and J. A. Berlin
Medical College of Pennsylvania, Veterans Affairs Medical Center, Section in Infectious Diseases, Philadelphia.
OBJECTIVE.--To assess the efficacy of intrathecal therapy with tetanus
antibody (antitetanus equine serum or human tetanus immune globulin) in
neonatal and adult tetanus using meta-analytical techniques. DATA
SOURCES.--Clinical trials identified by searching MEDLINE and by reviewing
bibliographies of published articles. STUDY SELECTION.--Studies in English
with concurrent controls treated without intrathecal therapy. DATA
EXTRACTION.--Data were extracted by one author and verified by the second;
conflicts were resolved by discussion. DATA SYNTHESIS.--No major treatment
effect was found in neonatal tetanus when all studies were considered. A
benefit was suggested for antitetanus equine serum in adult disease, but
this finding should be accepted with caution. Subgroup analyses were
limited in power. Methodological difficulties in neonatal and adult trials
were common and safety has not been established. CONCLUSIONS.--Intrathecal
therapy for tetanus with either antitetanus equine serum or human tetanus
immune globulin is not of proven benefit and should only be given in the
context of well-designed, controlled trials.
