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Cited by 38Diphtheria, Corynebacterium, and TetanusVitamin C and Antioxidants ResearchBacterial Infections and Vaccines

Vitamin C for preventing and treating tetanus

Open access
Hemilä, Harri, Koivula, Teija·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006665.pub3PMC PMC13034421
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Abstract

BACKGROUND: Tetanus is a severe disease that can be prevented by vaccination. In developing countries vaccination coverage is not always high. Cases still occur also in developed countries, particularly in elderly people owing to their reduced immuno protection. There are about 1 million tetanus cases per year globally. In animal studies, vitamin C has protected against various infections and bacterial toxins. In a study with rats, vitamin C protected against the purified tetanus toxin. OBJECTIVES: To assess the prophylactic and therapeutic effect of vitamin C on tetanus. SEARCH METHODS: In May 2013 we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations ); and Ovid EMBASE for this third update. SELECTION CRITERIA: Controlled trials of vitamin C as a prevention or treatment for tetanus, whether or not these were placebo controlled, in any language, published or unpublished. Two review authors independently made inclusion decisions. DATA COLLECTION AND ANALYSIS: Both review authors independently extracted data from trial reports and assessed methodological quality. Since one of the cells in a 2 × 2 table had no events, we calculated the odds ratio (OR) and its 95% confidence interval (CI) for case fatality rate by using the Peto-method. Another of the 2 × 2 tables had no empty cells and the inverse-variance method was used to calculate its risk ratio (RR) estimate and 95% CI. We also used the Fisher's exact test to calculate the exact 95% CI for the OR of the 2 × 2 table with the empty cell. MAIN RESULTS: One single trial was eligible for inclusion. This non-randomised, unblinded, controlled trial undertaken in Bangladesh involved 117 tetanus patients. Vitamin C at a dosage of 1 g/day was administered intravenously alongside conventional treatment. At recruitment, the participants were stratified into two age groups and the results were reported by age. There was a significant difference in the vitamin C effect between the two age groups (P = 0.01). In the tetanus patients aged 1 to 12 years (n = 62), vitamin C treatment was associated with a 100% reduction in case fatality rate (95% CI from -100% to -94%). In patients aged 13 to 30 years (n = 55), vitamin C treatment was associated with a 45% reduction in case fatality rate (95% CI from -69% to -5%). AUTHORS' CONCLUSIONS: A single, non-randomised, poorly reported trial of vitamin C as a treatment for tetanus suggests a considerable reduction in mortality. However, concerns about trial quality mean that this result must be interpreted with caution and vitamin C cannot be recommended as a treatment for tetanus on the basis of this evidence. New trials should be carried out to examine the effect of vitamin C on tetanus treatment.

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  • The effect of vitamin C in the prevention and treatment of pneumonia is uncertain.

    “The effect of vitamin C in the prevention and treatment of pneumonia is uncertain as well [196,197].”

    From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [196]

    The Abstract (page unavailable) says that human trials found vitamin C reduced the duration and severity of pneumonia, rather than describing its treatment effect as uncertain. The paper's objectives concern tetanus, and our copy does not assess whether vitamin C prevents pneumonia. (LLM, conf=0.72)

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  • Notwithstanding that the effect is absent in the general population, vitamin C can be effective under specific conditions, such as low levels of vitamin C, e.g., in people under physical stress.

    “Notwithstanding that the effect is absent in the general population, vitamin C can be effective under specific conditions, such as low levels of vitamin C, e.g., in people under physical stress [6,191,195,198].”

    From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [198]

    The Abstract (page unavailable) says vitamin C may matter under certain conditions, particularly where dietary intake is low, and may not affect immune function in the standard Western population. The claim makes that possible lack of effect categorical and adds people under physical stress as an example; the cited passages do not establish that example. (LLM, conf=0.84)

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  • The Cochrane library has not documented the preventive effect of vitamin C administration on the incidence of the common cold and found only a very mild effect on the duration of the common cold.

    “The Cochrane library has not documented the preventive effect of vitamin C administration on the incidence of the common cold and found only a very mild effect on the duration of the common cold.”

    From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [196]

    The Abstract (page not given) reports that vitamin C reduced the duration of the common cold. It does not characterize that reduction as very mild or address whether vitamin C prevents common-cold incidence; this review concerns tetanus. (LLM, conf=0.86)

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Cites

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Research works printed but not linked: 7

  1. Büller Souto A, Lima C. Action de la vitamine C sur la toxine du Bacillus perfringens. Memorias do Instituto Butantan 1939;12:265-95 [in Portuguese]; 297-311 [in French; same data].
  2. Farrar JJ, Yen LM, Cook T, Fairweather N, Binh N, Parry J, et al. Tetanus. Journal of Neurology, Neurosurgery, and Psychiatry 2000;69:292-301.
  3. Greenland 1994 Greenland S. Quality scores are useless and potentially misleading. American Journal of Epidemiology 1994;140:300-1.
  4. Hemilä H, Douglas RM. Vitamin C and acute respiratory infections. International Journal of Tuberculosis and Lung Disease 1999;3:756-61.
  5. Hrobjartsson A, Gøtzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment [correction in 2001;345:304; comments in 2001;344:1630-2 and 2001;345:1276-9]. New England Journal of Medicine 2001;344:1594-602.
  6. Klenner FR. Recent discoveries in the treatment of lockjaw with vitamin C and tolserol. Tri-State Medical Journal 1954;2(July):7-11.
  7. Rothman KJ, Greenland S. Small sample statistics for pure count data. Modern Epidemiology. 2nd Edition. London: Lippincott, Williams, Wilkins, 1998:250-2.

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Authors
Hemilä, H., & Koivula, T.
Affiliations
University of Helsinki (FI)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-11-13
Volume
2013
Issue
11
Pages
CD006665-CD006665
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd006665.pub3
PMC
PMC13034421
OpenAlex
W1608021186
Cited by
38
References
65
Citations by year
2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 12 · 2020: 6 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2014: 2 · 2013: 1 · 2012: 3
FWCI
0.17
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion, other-oa)
Funders
National Institute for Health and Care Research
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Diphtheria, Corynebacterium, and Tetanus
  • Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
vitamin C, tetanus, tetanus toxin, case fatality rate, tetanus prevention, tetanus treatment, intravenous vitamin C, age differences in treatment response, elderly patients, wound infection
MeSH terms
Adolescent, Adult, Age Factors, Ascorbic Acid, Bangladesh, Child, Child, Preschool, Humans, Infant, Tetanus, Vitamins

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