Dawaa Reference

infectious

Post-Exposure Tetanus Prophylaxis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian National Drug Formulary - Antimicrobial 2023 · CDC Tetanus Wound Management Guidelines 2023 · Human Tetanus Immunoglobulin 100 IU/mL solution for injection SmPC sections 4.2 and 4.4 (eMC product 5547) · Tetanus Prophylaxis - StatPearls - NCBI Bookshelf - disease-level clinical article (tetanus-prophylaxis-full.txt)

Verified against4 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023
  • Human Tetanus Immunoglobulin 100 IU/mL solution for injection SmPC sections 4.2 and 4.4 (eMC product 5547)
  • No dose - referral pathway, no medicine given in primary care
  • Tetanus Prophylaxis - StatPearls - NCBI Bookshelf - disease-level clinical article (tetanus-prophylaxis-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Muscle spasms with stiffness and pain [muscle cramps]
  • In adults, WHO requires a wound or injury plus at least one of painful muscle contraction, trismus, or risus sardonicus [trismus]
  • Trismus means fierce painful masseter spasm leaving the mouth unable to open [trismus]
  • A neonate who cried and sucked for the first two days then loses that ability from day 3 to day 28, with spasms or rigidity, is suspect [spasm]
  • Immunisation record matters: what was given, whether the course was finished, and any past reaction
  • Arrival from another country, above all a poorly resourced one, warrants extra caution

Signs — what you find (3)

  • Examine for rigidity, altered tone and spasm in the muscles [spasm]
  • For any wound, record its size and depth, the condition of the tissue, foreign bodies present, and anything suggesting reduced blood supply
  • Watch for autonomic instability: drenching sweats, fast pulse, and blood pressure swinging high or low [sweating]

Tests (5)

  • This is diagnosed clinically
  • No investigation is required beyond excluding mimics such as dental abscess or meningitis
  • Suspect it after a tetanus-prone injury in someone whose immunisation is incomplete
  • The spatula test touches the back wall of the oropharynx with a blunt instrument; reflex jaw spasm means tetanus
  • That bedside test is reported at 100% specificity with 94% sensitivity

If not this — what else fits (11)

  • Drug-induced dystonia
  • Strychnine poisoning, for example from rat poison
  • Neuroleptic malignant syndrome
  • Stiff-person syndrome
  • Dental infection producing trismus
  • Meningitis
  • Encephalitis
  • Hepatic encephalopathy
  • Status epilepticus
  • Malignant hyperthermia
  • Black widow spider envenoming

SourceStatPearls "Tetanus Prophylaxis" - disease-level clinical article

Presentation findings are traced to the source above.

1

TETANUS TOXOID

1st line

Forminjection

Adult dose and duration

0.5 mL IM single dose into deltoid muscle - single dose

Paediatric dose

(Children >= 2 months: 0.5 mL IM single dose (usually given as DTaP/Tdap))

Dose by age
2 months and over:0.5 mL IM single dose (usually given as DTaP/Tdap)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Toxoid vaccine that stimulates active immunity against tetanus toxin, given after a wound when the immunisation history is inadequate or uncertain; post-exposure prophylaxis alongside wound debridement, not treatment for established tetanus.

Cautions
  • For clean minor wounds, give a booster if >10 years since the last dose. For dirty or tetanus-prone wounds, give a booster if >5 years since the last dose.
  • Thorough wound debridement and cleaning is mandatory.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

No dose - referral pathway, no medicine given in primary care

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - In HIV/AIDS patients, HTIG is indicated regardless of immunization status or wound risk classification, overriding the usual criteria.
  • When tetanus immune globulin is given, part of the dose must be infiltrated around the wound itself, not all of it into a distant muscle.
  • Tetanus immune globulin can still be given up to 21 days after the injury in an unvaccinated patient who presents late.
  • RED FLAG - Do not give the vaccine to a patient who had an anaphylactic reaction to a previous dose, or who developed encephalopathy not otherwise explained within 7 days of a previous dose.
  • Take extra care before vaccinating a patient who had Guillain-Barre syndrome within 6 weeks of a previous dose, a previous Arthus-type reaction, or an underlying neurological condition.
  • Tdap is indicated in pregnancy between 27 and 36 weeks of gestation.
  • The pregnancy dose is repeated in every pregnancy regardless of when the last tetanus dose was given, and an unvaccinated pregnant woman needs a series of three doses 4 weeks apart.
  • A patient with no previous tetanus immunisation needs a full three-dose primary course, not a single injection.
  • A high-risk wound means one that is contaminated, a puncture, an avulsion, or caused by a missile, crushing, burns, an animal or human bite, or frostbite; a low-risk wound is clean and minor.
  • Tetanus-prone wounds may be left open rather than closed, to avoid creating the anaerobic conditions the organism needs.
  • Give prophylaxis as soon as possible after the injury, and still give it when the patient presents late, because the incubation period is long and variable.
3

TETANUS IMMUNE GLOBULIN (HUMAN)

add-on - not a substitute

Forminjection

Adult dose and duration

250 IU IM as a single dose; 500 IU where the wound is infected and cannot be surgically cleaned within 24 hours, or is deep or heavily contaminated - single dose

Paediatric dose

250 IU IM single dose for all ages

Dose source

Human Tetanus Immunoglobulin 100 IU/mL solution for injection SmPC sections 4.2 and 4.4 (eMC product 5547)

Why

Human tetanus immunoglobulin provides immediate passive immunity for tetanus-prone wounds in unimmunized patients

Cautions
  • Indicated for dirty wounds in individuals with incomplete (<3 doses) or unknown vaccination history.
  • Inject into a separate anatomical site from tetanus vaccine using separate syringe.
  • If the tetanus vaccine is being given at the same visit, it goes in a different site - not the same muscle, not mixed.
  • IgA deficiency is the anaphylaxis risk here - these patients can react to any IgA-containing blood product.
  • For prophylaxis, if intramuscular administration is contraindicated (bleeding disorders), the injection can be administered subcutaneously.
Egyptian brands
Egyptian brandManufacturerIndicative price
BERIGLOBIN P 160MG/ML I.M.AMP.CSL BEHERING-GMBH -GERMANY > 2S PHARMA GROUP30.00 EGP
TETAGAM P 250 I.U./ML I.M INJECTIONCSL BEHERING-GMBH -GERMANY > 2S PHARMA GROUP40.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.