Effect of magnesium sulfate administration on the survival of adult and pediatric non-neonatal tetanus patients in a tertiary hospital in the Philippines: A retrospective cohort study

Abstract

Background & Objective: Locally, there are no recommendations on the use of magnesium sulfate (MgSO4) among tetanus patients. Moreover, some neurologists are unaware of its benefits in this cohort. Most start MgSO4 only when the patients are in the severe stage, have signs of dysautonomia, or if the physician is confident in its administration. This paper will determine the effect of MgSO4 on the survival of adult and pediatric non-neonatal tetanus patients in a tertiary hospital in the Philippines.

Methods: This study utilized a retrospective cohort study design. Data from a previous study by Lanuza et al. (2024) was utilized. Baseline comparisons of MgSO4 versus non-MgSO4 groups were done using Wilcoxon rank sum test or independent t-test for continuous data while a Fisher Exact test was used for comparison of proportions. Those with a p-value lower than 0.2 were used for Cox regression analysis.

Results: Crudely, survival is better in the MgSO4 group, and although this became non-significant when confounders were accounted, the survival in the MgSO4 group was still markedly higher than non-MgSO4 group. In terms of age group, MgSO4 was beneficial in both pediatric and adult patients, but only significant on the latter. The survival of MgSO4 administered non-neonatal tetanus patients was significantly higher among severe tetanus patients and among those without dysautonomia.

Conclusion: Administration of MgSO4 in non-neonatal tetanus patients, may be effective in improving survival. Moreover, its benefit is magnified among adult patients, with severe tetanus and those with no dysautonomia.