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Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: a meta-analysis

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dc.contributor.author Kabura, L. en_US
dc.contributor.author Ilibagiza, D. en_US
dc.contributor.author Menten, J. en_US
dc.contributor.author Van den Ende, J. en_US
dc.date.accessioned 2007-12-06T14:45:13Z
dc.date.available 2007-12-06T14:45:13Z
dc.date.issued 2006 en_US
dc.identifier.issn 1360-2276 en_US
dc.identifier.doi http://dx.doi.org/10.1111/j.1365-3156.2006.01659.x
dc.identifier.other ITG-I3A en_US
dc.identifier.other ITG-CLA en_US
dc.identifier.other CLINIC en_US
dc.identifier.other U-TROPIC en_US
dc.identifier.other INTER en_US
dc.identifier.other U-CTU en_US
dc.identifier.other JIF en_US
dc.identifier.other DOI en_US
dc.identifier.other ABSTRACT en_US
dc.identifier.other FTB
dc.identifier.uri http://hdl.handle.net/10390/1627
dc.description The definitive version is available at www3.interscience.wiley.com
dc.description.abstract BACKGROUND: Mortality caused by tetanus is still a serious health problem in developing countries. Apart from immunization, early treatment with equine antitetanus serum (ATS) or human tetanus immunoglobulin (TIG) is the real treatment that can avoid death. On pathophysiological grounds intrathecal administration would be preferred because of high concentrations of the antiserum in cerebrospinal fluid and thus around the nerve roots. Many studies concluded on its effectiveness whereas others did not find any superiority of this method. However, most of those studies were not random and/or had no sufficient weight. OBJECTIVE: To assess the efficacy of intrathecal therapy with ATS in neonates and adults. METHODS: Meta-analysis: Clinical trials were identified by searching Medline, the Cochrane library and Current Contents. Published randomized studies in English or French comparing intrathecal therapy and intramuscular therapy (IMS) were analysed with Revman, R, and Stata software. Treatment effects were evaluated by relative risk (RR) between intrathecal vs. intramuscular administration. RESULTS: A total of 942 patients were included in 12 trials, 484 in the intrathecal group and 458 in the intramuscular one. The combined RR of mortality for intrathecal vs. IMS was 0.71 (95% CI, 0.62-0.81). The superiority of intrathecal therapy also emerged when the analysis was performed in subcategories of both adults and neonates and for high and low dose of intrathecal serotherapy. Intrathecal administration of ATS or TIG is more beneficial than intramuscular administration in the treatment of tetanus. en_US
dc.language English en_US
dc.publisher Blackwell Publishing
dc.subject Bacterial diseases en_US
dc.subject Tetanus en_US
dc.subject Immunoglobulins en_US
dc.subject Antitoxin en_US
dc.subject Intrathecal en_US
dc.subject Intramuscular en_US
dc.subject Clinical management en_US
dc.subject Meta-analysis en_US
dc.title Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: a meta-analysis en_US
dc.type Article en_US
dc.citation.issue 7 en_US
dc.citation.jtitle Tropical Medicine and International Health en_US
dc.citation.volume 11 en_US
dc.citation.pages 1075-1081 en_US
dc.publisher.place Oxford
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/16827708
dc.citation.jabbreviation Trop Med Int Health en_US


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