Diphtheria&tetanus Toxoid

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Contents 1 Indications 2 Contraindications 3 Dosage 4 Pharmacokinetics 5 Drug-interactions 6 Mechanism-of-action 7 Notes 8 More General Terms 9 Additional Terms 10 References

Indications

• active immunity against diphtheria & tetanus

Contraindications

• patients receiving immunosupressive agents
• prior anaphylactic, allergic or systemic reactions
• hypersensitivity to diphtheria or tetanus toxoid

• Caution:

• pregnancy is not a contraindication
• waiting until the 2nd trimester is prudent
• patients with a severe local reaction ( Arthus-type) should not be given another routine or emergency dose for 10 years

• pregnancy-category C
• safety in lactation ?

Dosage

• Infants & children (6 weeks to 1 year):

• 3 0.5 mL doses at least 4 weeks apart
• give reinforcing dose 6-12 months after 3rd injection

• Children 1-6 years:

• 2 0.5 mL doses at least 4 weeks apart
• give reinforcing dose 6-12 months after 2nd injection
• if final dose given after 7th birthday, use adult preparation
• Kinrix is combination vaccine for children 4-6 years of age

• Adults & children > 7 years of age:

• primary immunization

• 2 0.5 mL doses at least 4-6 weeks apart
• give reinforcing dose 6-12 months after 2nd injection

• boosters every 10 years
• 0.5 mL SC after penetrating wound if > 5 years since last booster

• elderly: a single booster after age 49
• Injection: (pediatric use):

• diphtheria 6.6-15 Lf units & tetanus 5-10 Lf units/0.5 mL 5 mL vials

• Injection: (adult use):

• diphtheria 1.5-2 Lf units & tetanus 5-10 Lf units/0.5 mL 5 mL vials

Pharmacokinetics

• elimination: liver Adverse reactions:

• common (> 10%)

• fretfulness
• drowsiness

• less common (1-10%)

• anorexia, vomiting, persistent crying

• uncommon (< 1%)

• transient fever, convulsions (rare), tenderness, swelling, redness, pain, Arthus-type hypersensitivity reaction, tachycardia, hypotension, urticaria, pruritus

Drug-interactions

• immunosuppressive agents decreased response to the vaccine

Mechanism-of-action

• stimulates immunity to diphtheria & tetanus by eliciting specific antibodies for bacterial toxins

Notes

• a single dose of Tdap should be given to adults age 19-64 to replace the next diphtheria- tetanus toxoid dT booster [5]

More General Terms

• toxoid
• vaccine

Additional Terms

• diphtheria
• DTaP-IPV (Kinrix)
• tetanus
• tetanus toxoid

References

1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 7
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
4. Centers for Disease Control and Prevention (CDC) Recommendations for preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. [1]
5. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
6. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010

diphtheria & tetanus toxoid (dT, Td)