Management of Generalized Adult Tetanus with Intermittent Intrathecal Baclofen Bolus: Overcoming Infrastructural Limitations in a Resource-Limited Setting.

Generalized tetanus presents a formidable therapeutic challenge, especially when refractory to conventional management. Standard treatment involves toxin neutralization, muscle spasm control (sedation and magnesium sulfate), and supportive care. However, refractory cases often necessitate prolonged intensive care and risk secondary complications. Intrathecal baclofen (ITB), a gamma-aminobutyric acid type B agonist that reduces spinal hyperexcitability, is highly effective. Although continuous ITB infusion is the established gold standard, its implementation is often constrained in resource-limited environments due to high equipment and technical demands. We studied three patients with severe, conventional treatment-resistant generalized tetanus. A history of incomplete booster immunization among these patients leaves them vulnerable. Unable to use a continuous pump for ITB, we turned to intermittent bolus ITB injections as a pragmatic clinical strategy. Administered with meticulous caution, this bolus approach-often requiring repeat, titrated doses-proved successful in achieving promising control of the dangerous muscle spasms while monitoring closely for complications.