Prophylactic
tetanus antitoxin is ineffective in the prevention of experimental
tetanus. That this may be true clinically is indicated by the fact that there are increasing numbers of cases of
tetanus in humans after prophylactic
tetanus antitoxin. Despite this known ineffectiveness and the high rate of reaction to
antitoxin (5 per cent), many physicians continue to use it prophylactically, apparently for medical legal reasons. Since
tetanus in civilian
wounds is so rare, occurring approximately once in every million
wounds, the routine use of
tetanus antitoxin will probably cause more harm than good. It has been demonstrated experimentally that
oxytetracycline is the most effective antimicrobial in the prevention of
tetanus. It is, therefore, believed that adequate
tetanus prophylaxis may be obtained by meticulous
debridement and cleansing of the
wound, by the administration of 1 gm.
oxytetracycline daily for five days, and by intradermal administration of
tetanus toxoid on the first, fourth and seventh days.
Tetanus antitoxin is not given unless contaminated
wounds have ben neglected for eight hours or more. In these instances, 15,000 units or more of
tetanus antitoxin is given.
Tetanus toxoid remains the best
wound prophylaxis and greater emphasis should be placed on immunizing entire populations.