Tetanus Immune Globulin (TIG) Treatment Recommendations
For tetanus prophylaxis, Tetanus Immune Globulin (TIG) at a dose of 250 units intramuscularly is recommended for individuals with wounds other than clean minor wounds who have unknown/uncertain tetanus vaccination history or fewer than 3 previous tetanus toxoid doses. 1, 2
Wound Management and TIG Indications
The decision to administer TIG depends on both wound characteristics and vaccination history:
Wound Classification:
- Clean, minor wounds: TIG not required regardless of vaccination history
- All other wounds (contaminated with dirt, feces, soil, saliva; puncture wounds; avulsions; wounds from crushing, burns, frostbite): TIG indicated for those with incomplete vaccination 3, 2
Vaccination History Assessment:
| Previous Tetanus Doses | Clean, Minor Wounds | All Other Wounds |
|---|---|---|
| Unknown or <3 doses | No TIG needed | TIG required |
| ≥3 doses | No TIG needed | No TIG needed |
Administration Guidelines
- Standard prophylactic dose: 250 units administered intramuscularly as a single dose 1, 2
- Children <7 years: Can calculate by body weight (4.0 units/kg), though administering the full 250 units is often advised regardless of size 2
- Concurrent vaccination: When both TIG and tetanus toxoid-containing vaccine are indicated:
Special Populations
- Immunocompromised patients: Should receive TIG for contaminated wounds regardless of vaccination history 1
- Pregnant women: Should receive Tdap if tetanus prophylaxis is indicated 1
- Contraindications to tetanus toxoid: If a person cannot receive tetanus toxoid and has a tetanus-prone wound, administer only TIG for passive immunization 3, 2
Treatment of Active Tetanus
While primarily used for prophylaxis, TIG is also indicated in the treatment of active tetanus:
- Dosage should be adjusted according to infection severity 2
- Some evidence suggests intrathecal administration of TIG may be more effective than intramuscular administration in treating active tetanus 4, 5
Important Clinical Considerations
- Proper wound cleaning is paramount for tetanus prevention, with TIG serving as adjunctive therapy 2
- Even with adequate immunization, tetanus can rarely occur in vaccinated individuals, as demonstrated by case reports of patients with protective antibody levels who still developed tetanus 6
- No significant increase in tetanus antitoxin levels occurs within the first 4 days following a booster dose, supporting the need for TIG in high-risk wounds even among previously vaccinated individuals whose last dose was >5-10 years ago 7
Pitfalls to Avoid
- Do not assume military service guarantees complete tetanus vaccination series 2
- Do not withhold TIG in patients with tetanus-prone wounds and uncertain vaccination history 2
- Do not administer TIG and tetanus toxoid at the same anatomical site 1, 2
- Do not forget that approximately 10% of tetanus cases have no identifiable wound or breach in skin/mucous membrane 2