{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:57:27Z","timestamp":1791385047123,"version":"4.3.3"},"reference-count":15,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>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\u2014often requiring repeat, titrated doses\u2014proved successful in achieving promising control of the dangerous muscle spasms while monitoring closely for complications.<\/jats:p>","DOI":"10.4269\/ajtmh.26-0220","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:49:50Z","timestamp":1786643390000},"page":"741-744","source":"Crossref","is-referenced-by-count":0,"title":["Management of Generalized Adult Tetanus with Intermittent Intrathecal Baclofen Bolus: Overcoming Infrastructural Limitations in a Resource-Limited Setting"],"prefix":"10.4269","volume":"115","author":[{"given":"Kashish","family":"Jindal","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chackappen","family":"Aymanom","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukesh","family":"Bairwa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Kant","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhilesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"10181","key":"b1","series-title":"Lancet","first-page":"1657","article-title":"Tetanus","volume":"393","author":"Yen","year":"2019"},{"key":"b2","article-title":"Immunization Coverage.","year":"2026"},{"issue":"9","key":"b3","series-title":"Dis Mon","first-page":"545","article-title":"Tetanus: pathophysiology, management, and prophylaxis","volume":"37","author":"Bleck","year":"1991"},{"issue":"9","key":"b4","series-title":"Clin Infect Dis","first-page":"1111","article-title":"Durability of vaccine-induced immunity against tetanus and diphtheria toxins: A cross-sectional analysis","volume":"62","author":"Hammarlund","year":"2016"},{"key":"b5","series-title":"Int J Infect Dis","first-page":"107781","article-title":"Risk factors and preventive role of vaccination in adult tetanus fatality: a systematic review of reported cases (1990\u20132024) and meta-analysis","volume":"153","author":"Kolsuz","year":"2025"},{"issue":"2","key":"b6","series-title":"Crit Care","first-page":"217","article-title":"Pharmacological management of tetanus: An evidence-based review","volume":"18","author":"Rodrigo","year":"2014"},{"issue":"4","key":"b7","series-title":"Intensive Care Med","first-page":"241","article-title":"Treatment of severe tetanus by intrathecal injections of baclofen without artificial ventilation","volume":"18","author":"Saissy","year":"1992"},{"key":"b8","series-title":"BMJ","first-page":"h2975","article-title":"India is declared free of maternal and neonatal tetanus","volume":"350","author":"Cousins","year":"2015"},{"issue":"8","key":"b9","series-title":"Intensive Care Med","first-page":"896","article-title":"Intrathecal baclofen in tetanus: Four cases and a review of the literature","volume":"23","author":"Dressnandt","year":"1997"},{"issue":"12","key":"b10","series-title":"ACS Chem 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management of tetanus","volume":"18","author":"Govindaraj","year":"2014"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/115\/4\/article-p741.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/115\/4\/article-p741.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/115\/4\/article-p741.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:24:47Z","timestamp":1791383087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/115\/4\/article-p741.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":15,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.26-0220","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}