What is the recommended dose of Tetanus Immunoglobulin (TIG) for wound management?

Recommended Dose of Tetanus Immunoglobulin (TIG)

The standard prophylactic dose of Tetanus Immunoglobulin (TIG) is 250 units administered intramuscularly for both adults and children when indicated for wound management. 1, 2

When TIG is Indicated

TIG administration depends on both wound classification and vaccination history:

For Contaminated/Tetanus-Prone Wounds

• Administer TIG 250 units IM if the patient has received fewer than 3 doses of tetanus toxoid-containing vaccine OR has an unknown vaccination history 1, 2
• Tetanus-prone wounds include those contaminated with dirt, feces, soil, or saliva; puncture wounds; avulsions; and wounds from missiles, crushing, burns, and frostbite 1, 2
• Do NOT give TIG if the patient has completed ≥3 doses of tetanus toxoid-containing vaccine, regardless of timing 1, 2

For Clean, Minor Wounds

• TIG is NOT indicated regardless of vaccination history 1, 2

Critical Administration Details

Concurrent Vaccine Administration

• When both TIG and tetanus toxoid-containing vaccine are indicated, administer them using separate syringes at different anatomical sites to prevent interference with immune response 1, 2
• Use only adsorbed tetanus toxoid when giving concurrent TIG 1

Special Populations Requiring TIG

• Immunocompromised patients (HIV infection or severe immunodeficiency) with contaminated wounds should receive TIG 250 units IM regardless of their tetanus immunization history 1, 2
• Pregnant women follow the same TIG guidelines as non-pregnant adults 2

Dose for Established Tetanus Cases

For patients with clinical tetanus (not prophylaxis):

• Administer 250-500 units IM immediately to neutralize circulating tetanospasmin 3
• Note that TIG cannot reverse damage from toxin already bound to the central nervous system 3

Common Pitfalls to Avoid

• Do not confuse the prophylactic dose (250 units) with treatment doses for established tetanus (250-500 units) 1, 2, 3
• Do not delay TIG administration in appropriate candidates—tetanus toxoid booster provides NO protection for the current injury, only future injuries 4, 5
• In mass-casualty settings with limited TIG supply, prioritize persons aged >60 years and immigrants from regions outside North America/Europe who are less likely to have adequate antibodies 2
• Human TIG is vastly superior to equine antitoxin due to longer protection duration and fewer adverse reactions 1, 3