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Routine Prophylactic Dosage Schedule:
Adults and Children ≥7 years: Hyper-Tet should be given by deep IM injection (see Precautions). At the same time, but in a different extremity and with a separate syringe, adsorbed tetanus and diphtheria toxoids (for adult use) (Td) should be administered. Adults with uncertain histories of a complete primary vaccination series should receive a primary series using the combined Td toxoid. To ensure continued protection, booster doses of Td should be given every 10 years.
Children <7 years: In small children, the routine prophylactic dose of Hyper-Tet may be calculated by the body weight (4 units/kg). However, it may be advisable to administer the entire contents of the vial or syringe of Hyper-Tet regardless of the child's size, since theoretically the same amount of toxin will be produced in the child's body by the infecting tetanus organism as it will in an adult's body. At the same time but in a different extremity and with a different syringe, diphtheria and tetanus toxoids and adsorbed pertussis vaccine (DTP) or adsorbed diphtheria and tetanus toxoids (for pediatric use) (DT), if pertussis vaccine is contraindicated, should be administered.
Note: The single injection of tetanus toxoid only initiates the series for producing active immunity in the recipient. The physician must impress upon the patient the need for further toxoid injections in 1 month and 1 year. Without such, the active immunization series is incomplete. If a contraindication to using tetanus toxoid-containing preparations exists for a person who has not completed a primary series of tetanus toxoid immunization and that person has a wound that is neither clean nor minor, only passive immunization should be given using tetanus immune globulin. (See table under Indications.)
Available evidence indicates that complete primary vaccination with tetanus toxoid provides long-lasting protection, ≥10 years for most recipients. Consequently, after complete primary tetanus vaccination, boosters, even for wound management, need be given only every 10 years when wounds are minor and uncontaminated. For other wounds, a booster is appropriate if the patient has not received tetanus toxoid within the preceding 5 years. Persons who have received at least 2 doses of tetanus toxoid rapidly develop antibodies. The prophylactic dosage schedule for these patients and for those with incomplete or uncertain immunity is shown on the table in Indications.
Since tetanus is actually a local infection, proper initial wound care is of paramount importance. The use of antitoxin is adjunctive to this procedure. However, in approximately 10% of recent tetanus cases, no wound or other breach in skin or mucous membrane could be implicated.
Active Cases of Tetanus: Standard therapy for the treatment of active tetanus including the use of Hyper-Tet must be implemented immediately. The dosage should be adjusted according to the severity of the infection.
Directions for Syringe Usage:
Remove the pre-filled syringe from the package. Lift syringe by barrel, not by plunger.
Twist the plunger rod clockwise until the threads are seated.
With the rubber needle shield secured on the syringe tip, push the plunger rod forward a few millimeters to break any friction seal between the rubber stopper and the glass syringe barrel.
Remove the needle shield and expel air bubbles.
Proceed with hypodermic needle puncture.
Aspirate prior to injection to confirm that the needle is not in a vein or artery.
Inject the medication.
Withdraw the needle and dispose or destroy it.
