From the Guidelines
For a 3-year-old patient requiring tetanus prophylaxis in the emergency room, I recommend administering DTaP as the tetanus toxoid-containing vaccine, as it is the preferred vaccine for children aged <7 years 1. If the wound is contaminated or high-risk (deep puncture, crush injury, or contaminated with dirt/saliva), tetanus immune globulin (TIG) should also be given at 250 units intramuscularly at a site separate from the vaccine. The decision to administer TIG depends on the child's immunization status and wound characteristics, as outlined in the guide to tetanus prophylaxis in routine wound management 1. Some key points to consider include:
- The number of doses of adsorbed tetanus toxoid–containing vaccines the child has received
- The type of wound (clean and minor or all other wounds)
- The child's immunization history and whether they have completed the primary tetanus vaccination series Antibiotics are not specifically required for tetanus prophylaxis but may be indicated based on the wound characteristics. If antibiotics are needed for wound infection, amoxicillin-clavulanate at 45 mg/kg/day divided twice daily for 5-7 days would be appropriate for most contaminated wounds. For penicillin-allergic patients, clindamycin (10 mg/kg/day divided three times daily) is an alternative. Proper wound cleaning is also essential for prevention, and the child's immunization record should be updated, with caregivers provided with information about completing the vaccination series if needed 1.