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Tetanus Prophylaxis

Robert M. Filler, M.D.; Walter Ellerbeck, M.D.
JAMA. 1960;174(1):1-4. doi:10.1001/jama.1960.03030010003001.
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Tetanus toxoid, tetanus antitoxin, and antibiotics have been compared in a review of the literature with regard to their value as prophylactic agents. Studies with antibiotics suggest that penicillin, tetracyclines, and chloramphenicol are effective against vegetative Clostridium tetani. On the basis of these considerations, a program for tetanus prophylaxis has been formulated. The immunized patient receives 0.5 ml. of tetanus toxoid at the time of injury. An antibiotic is added for massive wounds seen after 48 hours. The nonimmunized patient receives only local care for trivial wounds, and antibiotics (preferably 1,200,000 units of benzathine penicillin G intramuscularly) are added if the wound is more extensive. Tetanus antitoxin (5,000 to 10,000 units) is reserved for massive or extensive wounds seen late in the nonimmunized patient. Active immunization with toxoid is started in all nonimmunized patients.

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