Tetanus Immunoglobulin Dosage
The standard prophylactic dose of Tetanus Immunoglobulin (TIG) is 250 units administered intramuscularly for both adults and children, given at a separate anatomic site from tetanus toxoid using a separate syringe. 1, 2
Prophylactic Dosing for Wound Management
Administer TIG 250 units IM for patients with <3 previous tetanus toxoid doses or unknown/uncertain vaccination history who present with tetanus-prone wounds. 1, 2
TIG is NOT required for patients with ≥3 documented tetanus toxoid doses, regardless of wound type, unless they are severely immunocompromised. 2, 3
When administering TIG concurrently with tetanus toxoid, use separate syringes at different anatomical sites to prevent interference with the immune response. 1, 2, 3
Therapeutic Dosing for Established Tetanus
For patients with established tetanus disease, administer human TIG at a higher dose of 250-500 units IM immediately to neutralize circulating tetanospasmin. 3
Some sources suggest doses up to 1,000 units IM for treatment of established tetanus, though 250-500 units is the standard recommendation. 4
TIG cannot reverse damage from toxin already bound to neural tissue—it only neutralizes circulating toxin that has not yet reached the central nervous system. 3, 5
Alternative When TIG is Unavailable
If human TIG is unavailable, equine Antitetanus Serum (ATS) can be substituted at 1,500-3,000 IU IM for prophylaxis or 10,000-20,000 IU for treatment of established tetanus. 5
Human TIG is strongly preferred over equine ATS due to significantly lower risk of allergic reactions, longer duration of protection, and better safety profile. 3, 5
In mass-casualty settings with limited TIG supply, prioritize administration to patients >60 years and immigrants from regions outside North America/Europe, as they are least likely to have adequate antitetanus antibodies. 1, 2
Critical Clinical Considerations
Intravenous immune globulin (IVIG) may be substituted for TIG when TIG is unavailable, though no direct dose equivalency exists and efficacy data are limited. 1
Always administer tetanus toxoid vaccine concurrently with TIG (but at a separate site) to initiate active immunization, as passive immunization does not confer long-term immunity. 1, 2, 5
Patients receiving TIG must complete a 3-dose primary tetanus vaccination series for long-term protection. 1, 2
Antibiotic chemoprophylaxis against tetanus is NOT recommended or useful for wound management. 2