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(TET-ah-nus ih-MYOON GLAH-byoo-lin)
 Baytet
Class: Immune serum

 Action Directly neutralizes toxin excreted by Clostridium tetani, cause of tetanus.

 Indications Passive, transient protection against tetanus in any person with would that may be contaminated with tetanus spores when: (1) patient’s personal history of immunization with tetanus toxoid is unknown or uncertain, (2) person received < 2 prior doses of tetanus toxoid or (3) person received 2 prior doses of tetanus toxoid, but delay of > 24 hours occurred between time of injury and initiation of tetanus prophylaxis. unlabeled use(s): Treatment of clinical tetanus.

 Contraindications Hypersensitivity to human antibody product, thimerosal or other components; circulating anti-IgA antibodies.

 Route/Dosage

ADULTS: Prophylactic dose: IM 250 units. Give 500 units if wounds are severe or treatment is delayed. Dosage may be increased to 1000–2000 units. For therapy of tetanus, give 500–3000 or 6000 units. Give deep IM, preferably in upper outer quadrant of gluteal muscle. CHILDREN: IM Dose is calculated on basis of body weight (4 units/kg); however, it may be advisable to administer 250 units regardless of the size of the child. The same amount of toxin is produced by the bacteria in adults and children.

 Interactions There is no significant interaction between TIG and tetanus toxoid if given at different injection sites. To avoid inactivating vaccines containing live viruses or bacteria, give live vaccines 2–4 wk before or 12 wk after TIG.

 Lab Test Interferences None well documented.

 Adverse Reactions Local and systemic reactions following TIG are infrequent and usually mild. Expect some pain, tenderness and muscle stiffness at injection site, persisting for several hours. Hives, angioedema, nephrotic syndrome and local inflammation occur occasionally. Anaphylactic reactions are very infrequent.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Use TIG as soon as possible after tetanus-prone injuries. Do not inject IV.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer by IM injection only; do not give IV.
  • Refer to appropriate immunization schedule or CDC wound management guideline for correct dosing.
  • Use different syringe and injection site for the tetanus toxoid.
  • Remember that prior history of tetanus “shots” is not reliable unless it can be confirmed that these shots were tetanus toxoid. However, U.S. Armed Forces personnel since 1940 have received at least 1 dose and probably complete immunizing series. If tetanus toxoid is needed, give in a separate site.
  • Store in the refrigerator.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Observe patient for possible anaphylactic reaction after administration.

 Patient/Family Education

  • Alert patient that pain, soreness, inflammation or stiffness at site of injection may be experienced.
  • Advise patient who is also receiving tetanus toxoid series to complete pending immunizations since TIG protection is only temporary.

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