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October 7, 1968

Management of Clinical Tetanus

JAMA. 1968;206(2):375. doi:10.1001/jama.1968.03150020091026

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To the Editor:—  The reference for terms aluminum phosphate adsorbed toxoid and alum toxoid is given (Levine, et al: New Eng J Med274:186, 1966). As explained, these toxoids precipitated by aluminum phosphate or hydroxide are by custom referred as "alum toxoids." Their action is the same clinically.In tetanus prophylaxis in a nonimmunized patient when human hyperimmune serum is not available, from a practical standpoint one thoroughly cleanses and debrides the wound. There is then no devascularized or devitalized tissue to harbor clostridia. One must administer antibiotics before bacterologic reports are available, recognizing, as in all infections, that some strains may be resistant. Usually within 24 hours one can obtain human sera.It is customary to repeat antiserum in treating clinical tetanus because one cannot be certain more organisms are not present, and particularly with animal sera, one cannot be certain how long such antibodies will remain in