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10.20 Tetanus Prophylaxis


Presentation

The patient may have stepped on a nail, or sustained any sort of laceration, abrasion or puncture wound, when the question of tetanus prophylaxis comes up.

What to do:

What not to do:

Discussion:

There continue to be 50-100 cases of tetanus in the US each year. The CDC recommends everyone receive Td every 10 years, but somehow physicians and patients alike forget tetanus prophylaxis except after a wound. Because tetanus has followed negligible injuries and spontaneous infections, the concept of the "tetanus-prone wound" is not really helpful. The CDC recommends including a small dose of diphtheria toxin (Td) but, because this is more apt to cause local reactions, you may want to revert to plain tetanus toxoid (TT) in patients who have complained of such reactions.

Diptheria-pertussus-tetanus (DPT) vaccine is given at two, four and six months, with a fourth dose at 12 to 18 months (six months after the last dose), a fifth dose at four to six years, and a sixth dose at eleven to sixteen. Thereafter, tetanus toxoid with a reduced dose of diptheria (Td) is given ever ten years, and boosters within five for "tetanus-prone" wounds.

References:


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