Antitetanic serum alcohol. Indications and contraindications. Serum composition and release form

Tetanus is an acute infectious bacterial disease, which proceeds with the phenomena of damage nervous system in the form of generalized convulsions and tonic tension skeletal muscles. The disease is often fatal. Tetanus treatment is carried out in departments intensive care and resuscitation, where the patient is provided with round-the-clock monitoring and health care. Tetanus vaccination is carried out by repeated administration of multicomponent, ADS and ADS-M, which are the most effective tool against disease.

Antitetanus serum and immunoglobulin are used to treat and emergency prevention tetanus.

The causative agent of tetanus (Clostridium tetani) is a ubiquitous bacterium. She is opportunistic pathogen, lives in the intestines of animals and humans, where it lives and reproduces. With faeces, bacteria enter the soil, polluting the land of vegetable gardens, orchards and pastures.

The tetanus bacillus is a spore-forming bacterium. At favorable conditions(in the absence of free oxygen and sufficient humidity), spores germinate. Educated vegetative forms produce exotoxin tetanospasmin and exotoxin hemolysin. Tetanus exotoxin is the strongest bacterial poison, second in strength only to the toxin secreted by the spore-forming bacterium Clostiridium botulinum (botulinum toxin). Neutralize toxins human tetanus immunoglobulin and tetanus equine serum.

Rice. 1. In the photo on the left is Clostridium tetani (vegetative form). On the right are bacterial spores.

Tetanus treatment

Treatment of tetanus is carried out in intensive care and intensive care units, where the patient is monitored around the clock. Mode - strictly bed, protective. The room is darkened. The possibility of noise and other types of irritants that can provoke convulsions is excluded.

A sick person is not a spreader of the infection.

Nutrition of patients during the treatment of tetanus

It is difficult to organize good nutrition for the patient during the height of the disease. developed muscle hypertonicity prevents food intake through the mouth and its introduction through the probe. Difficult to do the same parenteral nutrition.

The patient is prescribed a high-calorie diet No. 11, which involves an increased content of proteins, especially of milk origin, vitamins and minerals. The amount of fats and carbohydrates is moderate. Culinary food processing is normal.

In order to compensate for the energy costs that occur during convulsions, the patient is prescribed tube nutrition with the addition of special dry products of dairy origin (enpits).

In some cases, the patient is prescribed parenteral nutrition (full or incomplete).

Rice. 2. The photo shows the first symptoms of tetanus. Right - tonic contraction chewing muscles(lockjaw). On the left - tonic contraction of mimic muscles ("sardonic smile").

Organization proper nutrition and proper patient care is essential.

Neutralization of tetanus exotoxin

Neutralizes tetanus exotoxin anti-tetanus serum and specific immunoglobulin. Anti-tetanus serum is administered intramuscularly at a dose of 50,000 IU. Specific immunoglobulin is administered at a dose of 1500 to 10,000 IU.

Due to the fact that tetanus exotoxin is in the blood for 2 to 3 days in a free state, the above drugs must be administered as early as possible. The toxin, which has already been fixed in the tissues, cannot be deactivated by any means.

Anticonvulsant therapy in the treatment of tetanus

Anticonvulsant therapy, the fight against hypoxia and homeostasis disorders are the basis of intensive care for tetanus.

Seizures are relieved by parenteral administration neuroleptics Aminazina and Droperidol, tranquilizers and sleeping pills (Chloral hydrate in enemas). good effect obtained from their combination with narcotic analgesics, antihistamines and barbiturs.

Severe convulsions are relieved by muscle relaxants. Patients are transferred to artificial ventilation lungs.

Rice. 3. In the photo, opistonus in a child (hyper-extension of the spine), which occurs as a result of the predominance of extensor reflexes.

Treatment of tetanus wounds

In order to combat tetanus pathogens, the wound is opened, treated (sanitized) and aerated. First, the wound is chipped with tetanus toxoid.

In order to create an influx of oxygen to the affected tissues (creation aerobic conditions) wide stripe incisions are made.

Carrying out the treatment of the wound under anesthesia will prevent the development of seizures.

Prevention of bedsores

The use of muscle relaxants obliges the medical staff to carry out the prevention of bedsores to the patient. The patient must often be turned in bed, smoothed out crumpled linen, often changed it. A good effect is the use of anti-decubitus mattresses.

Rice. 4. In the photo, opistonus in an adult.

Prevention and treatment of consequences and complications of tetanus

• Hypertonicity of the muscles involved in breathing leads to hypoxia of the patient. Increased mucus production. The drainage function of the bronchi is impaired. Against the background of congestion, bronchitis and pneumonia occur, which are complicated by pulmonary edema. For prevention and treatment bacterial complications antibiotics are used. The introduction of semi-synthetic penicillins, cephalosporins of I and II generations and others is shown.
• Spasm of the muscles of the perineum with tetanus is manifested by difficulty urinating and defecation. To alleviate the patient's condition, laxatives are prescribed. Gas tube facilitate the release of gases from the intestines. With difficulty urinating in bladder a catheter is placed.
• The great strength of the muscles during the period of contraction leads to the fact that they can break away from the place of attachment, a fracture of the vertebral bodies, dislocations of the joints, ruptures of muscles and tendons of the limbs and anterior abdominal wall develop compression deformity of the spine and muscle contractures. For a warning mechanical damage, which often occur with convulsions, is used whole complex preventive measures.
• Prolonged convulsions are accompanied by high energy costs, which contributes to the development of metabolic acidosis. During convulsions, the body temperature rises, it is noted increased excretion saliva and tachycardia, dehydration develops. The fight against the above manifestations of the disease is carried out by intravenous administration sodium bicarbonate solution, hemodez, plasma, protein preparations and saline solutions.

Treatment in the hospital lasts 1-3 months.

Rice. 5. In the photo there is a convulsions in a patient with tetanus.

Prevention of tetanus

Epidemiological surveillance

Epidemiological surveillance for tetanus is the continuous collection and analysis of information about the disease. Based on surveillance information, medical institutions determine the priorities for providing care to patients and preventing tetanus.

Preventive measures for tetanus

Preventive measures for the disease are divided into non-specific, specific and emergency.

A patient with tetanus does not pose a danger to others. Separation of contact persons and disinfection in the outbreak is not carried out.

Nonspecific tetanus prophylaxis

The main directions are not specific prevention tetanus:

• injury prevention at work and at home,
• early and thorough surgical treatment of wounds received at home or at work,
• proper treatment of umbilical and surgical wounds,
• sanitary and educational work among the population.

Rice. 6. Injuries, abrasions and splinters skin are the main entry gate for bacteria.

Specific tetanus prophylaxis

Specific tetanus prophylaxis is carried out in an emergency and planned. The tetanus vaccine involves the introduction of a vaccine into the body that helps develop immunity to the disease. Antibodies that are produced in response to the vaccine help to tolerate the disease more easily, which greatly speeds up the recovery process.

Neutralizes tetanus exotoxin anti-tetanus serum and specific immunoglobulin. These drugs are used for emergency tetanus prophylaxis.

Vaccination is the most effective remedy against the disease.

Any injury and wound, when there is a violation of the integrity of the skin and mucous membranes, are the reason for emergency prophylaxis of tetanus. Neutralizes tetanus exotoxin anti-tetanus serum and specific immunoglobulin.

Tetanus shot and vaccine

The protective level of immunity in tetanus is achieved by repeated administration DTP vaccines, which, in addition to tetanus, protects the body from diphtheria and whooping cough. The ADS vaccine and the ADS-M vaccine do not contain a pertussis component. The ADS-M vaccine contains a reduced amount of antigens and is widely used for revaccination of adults.

Tetanus toxoid (TA) is a vaccine that consists of inactivated tetanus toxin. In response to its introduction, tetanus immunity is formed in the human body.

Rice. 7. Tetanus vaccination is done by injecting DTP vaccine intramuscularly into the mid-thigh area. For older children, the vaccine is administered in the shoulder area.

Tetanus vaccination during routine prophylaxis for children is carried out by repeated administration of the DTP vaccine. Timing of vaccinations against tetanus correspond to the vaccination schedule.

Used to vaccinate children domestic vaccines DTP (ADS), and foreign vaccines (Pentaxim, Infanrix, Infanrix Hexa).

Vaccination of children is carried out from 3 one month old. Tetanus vaccination is given 3 times every 45 days. Re-vaccinations (revaccination) are given to children with ADS or ADS-M vaccines at the age of 7 and 14 years. Tetanus vaccinations for adults ADS-M are carried out once every 10 years.

When an adult cannot indicate the exact date the last vaccination against tetanus, he is vaccinated with the ADS-M vaccine. Tetanus vaccination is carried out 2 times with an interval of 45 days. Revaccination is carried out only once every 6 to 9 months.

After active immunization, the human body for 10 years retains the ability to quickly (in 2-3 days) produce antitoxin in response to reintroduction preparations containing AS-toxoid.

Rice. 8. Vaccination against tetanus during planned prophylaxis for children is carried out by repeated administration of the DTP or ATP vaccine.

Re-vaccination (revaccination) is aimed at supporting previously created immunity.

Contraindications to DTP tetanus vaccination

• With acute respiratory infections, vaccination can be carried out immediately after recovery.
• With neurological and allergic diseases vaccination is carried out during the period of remission.
• With progressive diseases of the nervous system and seizures on high temperature ADS vaccination is used.

Side effect of tetanus shot

Slight swelling of the injection site and redness are normal reaction for the administration of the vaccine.

• An increase in temperature in the post-vaccination period is removed by taking antipyretics.
• At high temperature body, cramps and redness of the injection site up to 8 cm in diameter or more, seek medical attention.

Adverse reactions to the administration of the DPT vaccine are extremely rare.

Can you wet a tetanus shot?

You can wet the DTP vaccine.

After vaccination, the immune system is strained, the child's body begins to produce antibodies, which somewhat reduces it. defensive forces. It is recommended to refrain from walking and water procedures during this period.

Emergency tetanus prophylaxis

Any injury and wound when there is a violation of the integrity of the skin and mucous membranes, burns, frostbite, animal bites, penetrating intestinal injuries, community-acquired abortions and childbirth, gangrene and tissue necrosis, long-term abscesses and carbuncles are the reason for emergency tetanus prophylaxis.

Rice. 9. In case of any damage to the integrity of the skin and mucous membranes, emergency tetanus prophylaxis is carried out.

Vaccinated and unvaccinated people are subject to emergency prophylaxis. During emergency prophylaxis, primary processing wounds and at the same time specific immunoprophylaxis is carried out.

Neutralizes tetanus exotoxin anti-tetanus serum and specific immunoglobulin. Anti-tetanus serum is administered intramuscularly at a dose of 50,000 IU. Specific tetanus toxoid immunoglobulin is administered at a dose of 1500 to 10,000 IU. If the patient has data on vaccinations against the disease, then 0.5 ml of ADS vaccine is administered.

As a rule, emergency tetanus prophylaxis is almost always carried out, since some people are not vaccinated against the disease, and it is not possible to establish the degree of immunity in each case. Due to the fact that tetanus exotoxin is in the blood for 2 to 3 days in a free state, the above drugs must be administered as early as possible. The toxin, which has already been fixed in the tissues, cannot be deactivated by any means.

All patients with tetanus are immunized with tetanus toxoid, since after past illness full immunity does not develop.

Anti-tetanus serum

Anti-tetanus serum contains specific immunoglobulins. It is used for the treatment and emergency prophylaxis of tetanus. Anti-tetanus serum has a pronounced detoxifying effect, it neutralizes tetanus toxins.

Hypersensitivity and pregnancy are contraindications to the administration of the drug. Allergy to the administration of serum is manifested by fever, itching, rash, joint pain and anaphylactic shock.

The drug is administered intravenously or into the spinal canal at the maximum early dates from the onset of the disease.

Violated integrity of the ampoule and lack of labeling, discoloration and transparency of the contents, expired expiration date make the drug unsuitable for use.

Rice. 10. In the photo, tetanus toxoid.

Human tetanus immunoglobulin

The drug contains immunoglobulins (IgG), which have the ability to neutralize tetanus toxoid.

Tetanus immunoglobulin is used for emergency prophylaxis of tetanus in people who have not received full course immunization with AS or in the case when the vaccination history is not known. The drug is administered intramuscularly. Side effect rarely noted.

The drug is therapeutic and prophylactic. Contains antibodies that neutralize the toxin Cl. tetani. It is a protein fraction of the blood serum of horses hyperimmunized with tetanus toxoid containing specific immunoglobulins. The protein fraction is purified by a concentrated method of peptic digestion and salt fractionation. AS-Anatoxin + tetanus toxoid at a dose of 3000 IU. Anti-tetanus serum is administered to patients as early as possible from the onset of the disease at a dose of 100,000-200,000 IU. Before the introduction of tetanus toxoid, an intradermal test is performed with purified horse serum diluted 1:100 to detect sensitivity to a foreign protein. Syringes with a division value of 0.1 ml and fine needles are used to set up samples. The diluted serum is injected intradermally into the flexor surface of the forearm in a volume of 0.1 ml. The reaction is recorded after 20 min.

The test is considered negative if the diameter of the edema or redness that appears at the injection site is less than 1 cm. The test is considered positive if the edema or redness reaches 1 cm or more in diameter. In case of a negative intradermal test, tetanus toxoid is administered s.c. in an amount of 0.1 ml ( a sterile syringe is used, the opened ampoule is closed with a sterile napkin). If there is no reaction after 30 minutes, the entire prescribed dose of serum s / c is injected using a sterile syringe (with preventive purpose), in / in or into the spinal canal (for therapeutic purposes). If a positive intradermal test occurs or if an anaphylactic reaction occurs to a s / c injection of 0.1 ml tetanus toxoid its further introduction is contraindicated. In this case, the introduction of PSCHI is shown.

The introduction of the drug is recorded in the established accounting form indicating the date of vaccination, dose, manufacturer of the drug, batch number, reaction to the administration of the drug. improper storage. Terms and conditions of storage. Serum is stored and transported in accordance with SP 3.3.2.1248-03 at a temperature of 2° to 8°C. Shelf life - 3 years. An expired drug should not be used. Type of immunity: artificial passive antitoxic.

35. Antigangrenous mono- and polyvalent sera.

The drug is therapeutic and prophylactic. Contains antibodies that neutralize the toxin Cl. perfringens (polyvalent - Cl. odematiens, Cl.novyi, Cl. septicum, Cl. histolyticum, Cl. sordellii). It is a protein fraction of the blood serum of horses hyperimmunized with anatoxin of pathogens of gaseous anaerobic infection containing specific immunoglobulins. The protein fraction is purified by a concentrated method of peptic digestion and salt fractionation. The ampoule contains one prophylactic dose - 30,000 international units (IU) of anti-gangrenous antitoxin activity: Cl. perfringens - 10000 IU, Cl. oedematiens - 10000 ME, Cl. septicum - 10000 ME.C therapeutic purpose serum is injected intravenously, very slowly, by drip method, usually mixed with a 0.9% solution for injection heated to body temperature of sodium chloride at the rate of 100-400 ml per 100 ml of serum. The serum is heated to (36 ± 0.5) ° C and administered: first 1 ml for 5 minutes, then 1 ml per minute. The serum must be administered by a doctor, or under his supervision. The amount of serum administered depends on the clinical condition of the patient. Usually, the therapeutic dose of antigangrenous serum is 150,000 IU: antiperfringens - 50,000 IU, protivoedematiens - 50,000 IU, antisepticum - 50,000 IU. 1:100 (ampoule marked in red) to test the patient's sensitivity to horse serum proteins. Purified horse serum diluted 1:100 is injected in a volume of 0.1 ml intradermally into the flexor surface of the forearm (using syringes in accordance with SP 3.3.2.1248-03 at a temperature of 2 to 8 ° C in a place inaccessible to children. Freezing is not allowed. Best before date.2 years. An expired drug should not be used.Type of immunity: artificial passive antitoxic.

In 1 ml tetanus antitoxin 3000 IU (prophylactic dose for emergency prophylaxis).

In 1 ml tetanus antitoxin 10,000, 20,000, or 50,000 IU (to treat tetanus).

Release form

Ampoules in a package of 5 pieces (serum has a blue marking) complete with 5 ampoules of diluted serum, which is used to determine the sensitivity.

pharmachologic effect

Neutralizes tetanus toxins.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Anti-tetanus serum contains immunoglobulins blood serum of horses immunized with tetanus toxin . Whey is purified and concentrated by peptic digestion. Specific antibodies serums neutralize tetanus toxin . The use of tetanus toxoid (of different activity) is indicated in the prevention and treatment of the disease.

Pharmacokinetics

During treatment tetanus at the earliest possible time, 10,000–20,000 IU is administered intravenously or into the spinal canal. The introduction is repeated until the disappearance convulsions . The drug can be used to treat tetanus in children from the first days of life. The dosage depends on the condition of the ball child.

Before the introduction of serum (in any case), prepare the means antishock therapy. Given the possibility of developing shock after the use of serum, the patient must be observed for 1-2 hours. Do not use the drug if the integrity of the ampoules is violated, there is no labeling, or if the color and transparency change.

Clear or slightly opalescent, colorless or yellowish liquid without sediment. It is a protein fraction of the blood serum of horses immunized with tetanus toxoid or toxin, which contains specific immunoglobulins, purified and concentrated by peptic digestion and salt fractionation.

Contains chloroform at a concentration of not more than 0.1%.

Compound

The ampoule contains one prophylactic dose equal to 3000 international units (IU).

Release form

Available in ampoules. The ampoule contains one prophylactic dose. Produced complete with purified horse serum diluted 1: 100, which is a clear, colorless liquid without sediment.

Serum anti-tetanus liquid.

Immunological and biological properties

Neutralizes tetanus toxin.

Indications

Urgent specific prophylaxis and treatment of tetanus.

Dosage and administration

Tetanus treatment. Anti-tetanus serum is administered to patients in the most as soon as possible from the onset of the disease at a dose of 100,000 - 200,000 IU.

Serum is administered intravenously or into the spinal canal after testing for foreign protein sensitivity. Depending on the severity of the disease, the administration of serum is repeated until the disappearance of reflex vessels.

Emergency prophylaxis of tetanus involves the primary surgical treatment of the wound and reproduction, if necessary, specific immunity against tetanus.

Emergency specific prophylaxis of tetanus is carried out with:

• injuries with violation of the integrity of the skin and mucous membranes
• frostbite and burns of the second, third and fourth degree;
• community abortions;
• childbirth outside medical institutions;
• gangrene or tissue necrosis of any type, abscesses;
• animal bites;
• penetrating damage to the gastrointestinal tract.

For emergency specific prophylaxis of tetanus, apply:

• AC toxoid;
• tetanus toxoid human immunoglobulin(PSCHI)
• in the absence of PSCHI - horse tetanus antitetanus serum purified concentrated liquid (PPS).

AS-anatoxin and PSCI are administered in accordance with the instructions for the use of these drugs.

Selection scheme prophylactic for emergency specific prophylaxis of tetanus is provided in Appendix No. 1.

Anti-tetanus serum for the purpose of emergency prevention of tetanus is administered subcutaneously at a dose of 3000 IU.

Side effect

Sometimes the introduction of serum is accompanied by various allergic reactions: immediate (immediately after the introduction of serum or after a few hours), early (on the 2nd-6th day) and remote (on the 2nd week and later).

These reactions are manifested by a symptomatic complex of serum sickness (fever, itching and rashes on the skin, joint pain, etc.) and, in rare cases, anaphylactic shock.

Contraindications

There are no contraindications for the use of tetanus toxoid serum for therapeutic purposes.

Contraindications for the use of specific means of emergency prophylaxis of tetanus:

1. Presence in history hypersensitivity to the respective drug.

2. Pregnancy

• in the first half, the introduction of AS-anatoxin and PPS is contraindicated;
• in the second half, the introduction of PPS is contraindicated.

Application features

The drug is unsuitable for use if the integrity of the ampoules is broken or in the absence of labeling, the expired expiration date has ended, if the physical properties and improper storage.

Before the introduction of tetanus toxoid serum, an intradermal test with purified horse serum diluted 1: 100 should be performed to test sensitivity to foreign protein. For setting samples, a syringe is used, it has divisions of 0.1 ml and a thin needle. The diluted serum is injected intradermally into the flexor surface of the forearm in a volume of 0.1 ml. Watch for 20 minutes.

The sample is considered negative if the diameter of the edema or redness that appears at the injection site is less than 1 cm. The sample is considered positive if the edema or redness reaches 1 cm or more in diameter.

With a negative intradermal test, tetanus toxoid is injected subcutaneously in an amount of 0.1 ml (a sterile syringe is used, the open ampoule is closed with a sterile napkin). If there is no reaction after 30 minutes, the entire prescribed dose of serum is injected using a sterile syringe subcutaneously (for prophylactic purposes), intravenously or into the spinal canal (for therapeutic purposes).

With a positive intradermal test or if anaphylactic reaction on the subcutaneous injection 0.1 ml of tetanus toxoid, its further maintenance is contraindicated. In this case, you should enter PSCHI.

Last update of the description by the manufacturer 31.07.1996

Filterable List

Active substance:

ATX

Pharmacological group

Nosological classification (ICD-10)

Composition and form of release

1 ampoule of 2, 3 or 5 ml of the drug for emergency prophylaxis of tetanus contains one prophylactic dose (3000 IU) of tetanus antitoxin activity; 1 ampoule of 10 or 20 ml of the drug for the treatment of tetanus - 10,000, 20,000 or 50,000 IU. Preservative - chloroform (in finished product not defined); the content of sodium chloride is up to 0.9%. The package contains 5 ampoules of serum (blue marking) and 5 ampoules of 1 ml of serum diluted 1:100 - to determine the sensitivity of a person to a foreign protein.

Characteristic

pharmachologic effect

Neutralizes tetanus toxins.

Indications for the preparation Antitetanic horse serum purified concentrated

Tetanus (treatment and emergency prevention).

Contraindications

There are no contraindications for therapeutic use. For use with the purpose of emergency prevention: hypersensitivity, pregnancy.

Side effects

Allergic reactions: fever, itching, rash, arthralgia, anaphylactic shock.

Dosage and administration

In / in, into the spinal canal (as early as possible from the onset of the disease) at a dose of 10,000-20,000 IU. P / c (for emergency prevention) at a dose of 3000 IU.

Precautionary measures

Before the introduction of serum, it is necessary to prepare means of anti-shock therapy. The drug is not suitable for use in ampoules with broken integrity or lack of labeling, with a change in physical properties (color, transparency, the presence of unbreakable flakes), with an expired shelf life, improper storage.

Storage conditions of the drug Serum tetanus toxoid horse purified concentrated

Keep out of the reach of children.

Expiry date of the drug Serum tetanus toxoid horse purified concentrated

Do not use after the expiry date stated on the packaging.