Intervention Review

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Vitamin C for preventing and treating tetanus

  1. Harri Hemilä*,
  2. Teija Koivula

Editorial Group: Cochrane Wounds Group

Published Online: 13 NOV 2013

Assessed as up-to-date: 16 JUN 2013

DOI: 10.1002/14651858.CD006665.pub3

How to Cite

Hemilä H, Koivula T. Vitamin C for preventing and treating tetanus. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD006665. DOI: 10.1002/14651858.CD006665.pub3.

Author Information

  1. University of Helsinki, Department of Public Health, POB 41, Helsinki, Finland

*Harri Hemilä, Department of Public Health, POB 41, University of Helsinki, Mannerheimintie 172, Helsinki, FIN-00014, Finland.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 13 NOV 2013


Characteristics of included studies [ordered by study ID]
Jahan 1984

MethodsNon randomised; allocation method not described.
Vitamin C and control participants treated in separate wards.
No placebo; no blinding.
Duration up to 4 weeks.

Participants117 tetanus patients admitted to the Infectious Disease Hospital, Dhaka, Bangladesh.
Age group 1 to 12 years: 31 vitamin C, 31 control.
Age group 13 to 30 years: 27 vitamin C, 28 control.

InterventionsVitamin C intravenously 1 g/day vs. no vitamin C. Both groups received standard treatment.

OutcomesCase fatality rate.

NotesPoorly described trial (see Risk of bias in included studies).
Additional information was received from the first author, Professor Jahan.

Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High risk"we selected two wards side by side. Patients of one ward were under treatment with vitamin C in addition to conventional treatments. In another ward patients were enrolled as a control group and got only the conventional treatment (without vitamin C)". Personal communication with trial author. No randomisation took place.

Allocation concealment (selection bias)High riskAllocation method not described, see above

Blinding of participants and personnel (performance bias)
All outcomes
High riskPatients in one ward were administered vitamin C and patients in another ward served as control. This was known to personnel but it is not clear whether it was known to the patients

Blinding of outcome assessment (detection bias)
All outcomes
Low riskMortality in a hospital is not biased by subjective observations

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo drop outs according to the report

Comparison 1. Vitamin C vs control

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Case fatality rate1Peto Odds Ratio (Peto, Fixed, 95% CI)Totals not selected

    1.1 aged 1 to 12 years
1Peto Odds Ratio (Peto, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.2 aged 13 to 30 years
1Peto Odds Ratio (Peto, Fixed, 95% CI)0.0 [0.0, 0.0]