Therapeutic targets
- Elimination of the pathogens
- Avoidance of complications
Therapy recommendations
- In addition to drug therapy (tetanus immunoglobulin; antibiotic: metronidazole, agent of first choice), surgical wound care (= thorough surgical rehabilitation of the wound) must always be performed.
- Postexposure prophylaxis [see below].
- See also under “Further therapy“.
Postexposure prophylaxis (PEP)
Post-exposure prophylaxis is the provision of medication to prevent disease in individuals who are not protected against a particular disease by vaccination but have been exposed to it.
In case of injury
Note: Even minor injuries can be ports of entry for tetanus pathogens or spores and should be cause for the attending physician to review current tetanus immunization protection.
Tetanus immunoprophylaxis in case of injury.
| Documented tetanus vaccination status | Time since last vaccination | TdaP/Tdap2 | Tetanus immunoglobulin (TIG)3 | |
| Clean minor wounds | Unvaccinated or unknown | Yes | Yes | |
| 1 or 2 doses of vaccine | Yes4 | No | ||
| ≥ 3 doses of vaccine | ≥ 10 years | Yes | No | |
| <10 years | No | No | ||
| All other wounds1 | <3 doses of vaccine or unknown | Yes4 | Yes | |
| ≥ 3 doses of vaccine | ≥ 5 years | Yes | No | |
| < 5 years | No | No |
1 Deep and/or contaminated wounds (contaminated with dust, soil, saliva, feces), injuries with tissue fragmentation and reduced oxygen supply or foreign body penetration (e.g., crush, laceration, bite, puncture, gunshot wounds), severe burns and frostbite, tissue necrosis, septic abortions.
2 Children younger than 6 years receive combination vaccine with TDaP; older children and adolescents receive Tdap. Adults also receive Tdap if they have not received pertussis vaccine in adulthood (≥ 18 years) or if there is a current indication for pertussis vaccination.
3 TIG = tetanus immunoglobulin. Generally, 250 IU of TIG is administered. TIG is applied simultaneously with the TDaP or Tdap vaccine contralaterally. The TIG dose may be increased to 500 IU for: (a) infected wounds where adequate surgical treatment is not warranted within 24 h; (b) deep or contaminated wounds with tissue fragmentation and reduced oxygen supply; (c) foreign body penetration (e.g., bite, puncture, or gunshot wounds); (d) severe burns and frostbite, tissue necrosis, and septic abortions.
4 In the case of patients in whom basic immunization has been initiated but not yet completed (e.g., infants), the interval from the last dose must be considered. Post-exposure vaccination on the day of wound care is only useful if the interval to the previous vaccine dose is at least 28 days. Regarding the completion of a basic immunization, the STIKO’s post-exposure vaccination recommendations apply in all other respects.
