The basic principles of adequate and rational prophylactic treatment of tetanus are: (1) tetanus toxoid immunization prior to injury; (2) proper surgical management of wounds; (3) administration of toxoid booster; (4) use of antibiotics when indicated; (5) use of human immune globulin. For patients who have been previously immunized against tetanus with traumatic wounds, a booster of 0.5 ml. of toxoid is sufficient. For those with wounds which indicate an overwhelming possibility of tetanus, the booster of toxoid should be supplemented with 500 units of human tetanus globulin. The use of penicillin or tetracycline in adequate dosages should be considered. Last but not least, the wound should be thoroughly cleansed and adequately debrided. For those patients not previously immunized and whose wound is clean, start the basic three immunizations with 0.5 ml. of toxoid at four week intervals for three doses and a reinforcing dose a year later. For more severe wounds, supplement the toxoid with 250 units of human tetanus immune globulin, and if the wound is severe, neglected, or old, 500 units is advisable. Thorough cleansing and debridement of the wound is an important part of the management. Consider the use of penicillin or oxytetracycline in adequate dosage when indicated. The use of equine or bovine antitoxin is only mentioned to be condemned because of the high incidence of allergic and sometimes anaphylactic reactions, and because of the ready availability of human tetanus globulin.
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