In burn patients with unknown or incomplete tetanus immunization and a tetanus-prone wound, which prophylaxis is indicated?

• A. Tetanus toxoid booster only
• B. Antibiotic prophylaxis
• C. Administer tetanus immune globulin and a tetanus toxoid booster
• D. No prophylaxis unless contaminated

Answer: (C)

When a burn wound is tetanus-prone and immunization history is unknown or incomplete, you need both immediate protection and long-term immunity. Tetanus immune globulin provides passive, short-term protection by neutralizing any toxin that may be produced right now. A tetanus toxoid booster starts active immunity, prompting the patient’s immune system to make its own antibodies for lasting protection, but it takes a bit longer to become effective. Using both ensures the toxin is neutralized immediately and durable immunity is established for the future. Antibiotic prophylaxis targets bacterial infection, not toxin neutralization, and no prophylaxis would leave the patient at risk in a tetanus-prone wound. So the correct approach is to administer tetanus immune globulin and a tetanus toxoid booster.