•Antibiotics and wound debridement to halt toxin production – All patients with tetanus should undergo thorough wound debridement to eradicate spores and necrotic tissue, because C. tetani can persist in wounds despite prolonged antibiotic therapy.

For antibiotic therapy in patients with tetanus, we suggest metronidazole 500 mg intravenously (IV) every six to eight hours over other agents (Grade 2C). IV penicillin G (2 to 4 million units IV every four to six hours) is a safe and effective alternative. The duration of treatment is 7 to 10 days. (See 'Wound debridement' above and 'Antibiotic therapy' above.)