Regarding Tetanus Prophylaxis

A 19-year-old man presents with a compound fracture of his leg following a fall from scaffolding. Examination reveals soiling of the wound with mud. He is sure he has had five previous tetanus vaccinations. What is the most appropriate course of action to prevent the development of tetanus?

A. Clean wound + intramuscular human tetanus immunoglobulin
B. Clean wound + tetanus vaccine
C. Clean wound + tetanus vaccine + intramuscular human tetanus immunoglobulin
D. Clean wound + tetanus vaccine + benzylpenicillin
E. Clean wound

Answer:
A. Clean wound + intramuscular human tetanus immunoglobulin

Discussion: A soiled, compound fracture is regarded as high-risk for tetanus and intramuscular human tetanus immunoglobulin should be given. There is a role for antibiotics given the soiled wound although benzylpenicillin would not be the drug of choice.

Tetanus: vaccination The tetanus vaccine is a cell-free purified toxin that is normally given as part of a combined vaccine.

Tetanus vaccine is currently given in the UK as part of the routine immunisation schedule at:
 2 months
 3 months
 4 months
 3-5 years
 13-18 years

This therefore provides 5 doses of tetanus-containing vaccine. Five doses is now considered to provide adequate long-term protection against tetanus.

 Intramuscular human tetanus immunoglobulin should be given to patients with high-risk wounds (e.g. Compound fractures, delayed surgical intervention, significant degree of devitalised tissue) irrespective of whether 5 doses of tetanus vaccine have previously been given

If vaccination history is incomplete or unknown then a dose of tetanus vaccine should be given combined with intramuscular human tetanus immunoglobulin for high-risk wounds