Tetanus, prophylaxis: IM: 250 units as a single dose. May also calculate 4 units/kg; however, full dose of 250 units is recommended (Bradley 2021; Red Book [AAP 2018]); manufacturer's labeling).
Tetanus, treatment: Limited data available, dosing regimens variable: IM: 3,000 to 6,000 units as a single dose. Infiltration of part of the dose around the wound is recommended. Some experts recommend a lower 500 unit dose which appears to be as effective as higher doses and may cause less discomfort (Bradley 2021; Red Book [AAP 2018]; WHO 2010).
Tetanus, prophylaxis:
Infants and Children <7 years: IM: 250 units as a single dose. May also calculate 4 units/kg; however, full dose of 250 units is recommended (Red Book [AAP 2018]; manufacturer's labeling).
Children ≥7 years and Adolescents: IM: 250 units as a single dose (Red Book [AAP 2018]; manufacturer's labeling).
Note : Tetanus prophylaxis in patients with wounds should be based on if the wound is clean or contaminated and the immunization status of the patient. Wound management includes proper use of tetanus toxoid and/or tetanus immune globulin (TIG), wound cleaning, and (if required) surgical debridement and the proper use of antibiotics. Patients with an uncertain or incomplete tetanus immunization status should have additional follow-up to ensure a series is completed. Patients with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose even if they have a wound that is neither clean nor minor (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]). See table.
History of tetanus immunization doses |
Clean, minor wounds |
All other woundsa | ||
---|---|---|---|---|
aSuch as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; wounds from crushing, tears, burns, and frostbite. | ||||
bTetanus toxoid in this chart refers to a tetanus toxoid containing vaccine. For children ≤6 years of age, DTaP (DT, if pertussis vaccine contraindicated) is recommended. For children 7 to 10 years who are not fully immunized against pertussis, diphtheria, or tetanus, Tdap should be used (followed by completion of catch-up series). Tdap is preferred in patients ≥11 years of age if the patient has not previously been vaccinated with Tdap, if Tdap history is unknown, or if the patient is pregnant. In patients who have previously been vaccinated with Tdap, either Td or Tdap may be used. | ||||
cFor patients with HIV infection or severe immunodeficiency with contaminated wounds, TIG should be administered, regardless of history of tetanus immunization. | ||||
Abbreviations: DT = Diphtheria and Tetanus Toxoids (formulation for age ≤6 years); DTaP = Diphtheria and Tetanus Toxoids, and Acellular Pertussis (formulation for age ≤6 years; Daptacel, Infanrix); Td = Diphtheria and Tetanus Toxoids (formulation for age ≥7 years; Tenivac); Tdap = Diphtheria and Tetanus Toxoids, and Acellular Pertussis (Adacel or Boostrix [formulations for age ≥7 years]); TIG = Tetanus Immune Globulin | ||||
Tetanus toxoidb |
TIG |
Tetanus toxoidb |
TIG | |
Uncertain or <3 doses |
Yes |
No |
Yes |
Yes |
≥3 doses |
Only if ≥10 years since last dose |
No |
Only if ≥5 years since last dose |
Noc |
Tetanus, treatment: Limited data available; dosing regimens variable: Infants, Children, and Adolescents: IM: 3,000 to 6,000 units as a single dose. Infiltration of part of the dose around the wound is recommended. Some experts recommend a lower 500 unit dose which appears to be as effective as higher doses and may cause less discomfort (Bradley 2021; Red Book [AAP 2018]; WHO 2010).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Tetanus immune globulin (human): Drug information")
Tetanus, prophylaxis: IM: 250 units in conjunction with a tetanus toxoid-containing vaccine. Note: Tetanus prophylaxis in patients with wounds should be based on if the wound is clean or contaminated and the immunization status of the patient. Wound management includes proper use of tetanus toxoid and/or tetanus immune globulin (TIG), wound cleaning, and (if required) surgical debridement and the proper use of antibiotics. Patients with an uncertain or incomplete tetanus immunization status should have additional follow-up to ensure a series is completed. Patients with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose even if they have a wound that is neither clean nor minor (CDC/ACIP [Liang 2018]). See table.
History of tetanus immunization doses |
Clean, minor wounds |
All other woundsa | ||
---|---|---|---|---|
Tetanus toxoidb |
TIG |
Tetanus toxoidb |
TIG | |
aSuch as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; wounds from crushing, tears, burns, and frostbite. | ||||
bTetanus toxoid in this chart refers to a tetanus toxoid-containing vaccine. For children age <7 years, DTaP (DT, if pertussis vaccine contraindicated) is preferred to tetanus toxoid alone. For children age ≥7 years and adults, Td is preferred to tetanus toxoid alone; Tdap may be preferred if the patient has not previously been vaccinated with Tdap or if tetanus vaccine is indicated for a pregnant woman. | ||||
cFor patients with HIV infection or severe immunodeficiency with contaminated wounds, TIG should be administered, regardless of history of tetanus immunization. | ||||
Abbreviations: DT = diphtheria and tetanus toxoids (formulation for age ≤6 years); DTaP = diphtheria and tetanus toxoids, and acellular pertussis (formulation for age ≤6 years; Daptacel, Infanrix); Td = diphtheria and tetanus toxoids (formulation for age ≥7 years; Tenivac); Tdap = diphtheria and tetanus toxoids, and acellular pertussis (Adacel or Boostrix [formulations for age ≥7 years]); TIG = tetanus immune globulin. | ||||
Uncertain or <3 doses |
Yes |
No |
Yes |
Yes |
≥3 doses |
Only if ≥10 years since last dose |
No |
Only if ≥5 years since last dose |
Noc |
Tetanus, treatment: IM: 3,000 to 6,000 units. Infiltration of part of the dose around the wound is recommended (CDC 2015a). Some experts recommend a lower 500 unit dose which appears to be as effective as higher doses and may cause less discomfort (CDC 2015a; WHO 2010).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injectable, Intramuscular:
HyperTET S/D: 250 units/mL (1 ea)
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Prefilled Syringe, Intramuscular:
HyperTET: 250 units/mL (1 ea)
HyperTET S/D: 250 units/mL (1 ea)
Parenteral: IM: For IM use only; do not administer IV. Administer into lateral aspect of thigh or deltoid muscle of upper arm. Avoid gluteal region due to risk of injury to sciatic nerve. Do not administer tetanus toxoid and tetanus immune globulin in same syringe (toxoid will be neutralized); tetanus toxoid may be administered at the same time in separate limbs. When administered for treatment of tetanus, part of dose may be infiltrated locally around the wound site (CDC 2020; Red Book [AAP 2018]).
IM: For IM use only; do not administer IV. Administer in the anterolateral aspects of the upper thigh or the deltoid muscle of the upper arm. Avoid gluteal region due to risk of injury to sciatic nerve; if gluteal region is used, administer only in the upper outer quadrant. If tetanus vaccine and tetanus immune globulin are administered simultaneously, separate syringes at different anatomical sites should be used for each injection. When used for the treatment of tetanus, infiltration of part of the dose around the wound is recommended (CDC 2015a).
Store at 2°C to 8°C (26°F to 46°F). Do not use if frozen.
Prophylaxis for tetanus following injury in patients whose immunization for tetanus is incomplete or uncertain (FDA approved in pediatric patients [age not specified] and adults); has also been used in the treatment of tetanus.
The Advisory Committee on Immunization Practices (ACIP) recommends passive immunization with tetanus immune globulin (TIG) for the following:
• Persons with a wound that is not clean or minor and who have received ≤2 or an unknown number of adsorbed tetanus toxoid doses (CDC/ACIP [Liang 2018]).
• Persons who have HIV infection or severe immunodeficiency who have a wound that is not clean or minor, regardless of tetanus immunization history (CDC/ACIP [Liang 2018]).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined:
Central nervous system: Increased body temperature
Local: Local soreness/soreness at injection site, pain at injection site, tenderness at injection site
<1%, postmarketing, and/or case reports: Anaphylactic shock, angioedema, nephrotic syndrome
There are no contraindications listed in the manufacturer’s labeling.
Concerns related to adverse effects:
• Anaphylaxis/hypersensitivity reactions: Hypersensitivity and anaphylactic reactions can occur; immediate treatment (including epinephrine 1 mg/mL) should be available. Use with caution in patients with isolated immunoglobulin A deficiency or a history of systemic hypersensitivity to human immunoglobulins.
Disease-related concerns:
• Bleeding disorders: Use with caution in patients with thrombocytopenia or coagulation disorders; IM injections may be contraindicated.
Dosage form specific issues:
• Human plasma: Product of human plasma; may potentially contain infectious agents which could transmit disease. Screening of donors, as well as testing and/or inactivation or removal of certain viruses, reduces the risk. Infections thought to be transmitted by this product should be reported to the manufacturer.
Other warnings/precautions:
• Administration: Not for intravenous administration.
• Appropriate use: When used for the treatment of tetanus infection, TIG removes circulating toxin, but does not remove toxin bound to nerve endings (CDC 2012). Larger doses of TIG are needed for treatment than prophylaxis (see Dosage) (MMWR 2015).
• Skin testing: Skin testing should not be performed as local irritation can occur and be misinterpreted as a positive allergic reaction.
None known.
Efgartigimod Alfa: May diminish the therapeutic effect of Fc Receptor-Binding Agents. Risk C: Monitor therapy
Vaccines (Live): Immune Globulins may diminish the therapeutic effect of Vaccines (Live). Management: Live organism vaccination should be withheld for as long as 6 to 11 months following immune globulin administration. Recommendations vary by product and immune globulin dose, see full monograph for details. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted. Tetanus immune globulin and a tetanus toxoid containing vaccine are recommended by the ACIP as part of the standard wound management to prevent tetanus in pregnant women (CDC 57[RR6], 2008; CDC 62[7], 2013).
Provides passive immunity towards tetanus by supplying antibodies to neutralize the free form of toxins produced by Clostridium tetani.
Half-life elimination: Individuals with normal IgG concentration: ~23 days
Time to peak, plasma: IgG concentration: IM: ~2 days
Solution Prefilled Syringe (HyperTET S/D Intramuscular)
250 units/mL (per each): $701.06
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