# Post-Exposure Tetanus Prophylaxis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Tetanus toxoid — injection - Referral & safety-netting (no drug therapy) - Tetanus immune globulin (human) — injection ## Complete treatment card ```text POST-EXPOSURE TETANUS PROPHYLAXIS 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Tetanus Prophylaxis" - disease-level clinical article Status traced to the source above 1. TETANUS TOXOID [1st line] Adult 0.5 mL IM single dose into deltoid muscle - single dose Peds 2 months and over: 0.5 mL IM single dose (usually given as DTaP/Tdap) (Children >= 2 months: 0.5 mL IM single dose (usually given as DTaP/Tdap)) 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. Caution 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. Egypt no Egyptian brand matched - prescribe by generic name 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult 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 Peds 250 IU IM single dose for all ages 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 Caution 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. Egypt BERIGLOBIN P 160MG/ML I.M.AMP. CSL BEHERING-... 30.00 EGP TETAGAM P 250 I.U./ML I.M INJECTION CSL BEHERING-GMBH -GERMANY > 2S PHA... 40.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)