What are the other treatment choices?
Although proper wound hygiene has been known since the 1940's to be the best way to prevent infection, it tends to be overlooked as the best way to prevent tetanus. Regardless of immunization status, dirty wounds should be properly cleaned and crushed tissue should be surgically removed.
Diphtheria infections can be prevented by thorough hand washing and good nutrition.
Antibiotic regimens are available for the treatment of both tetanus and diphtheria infections. The Red Book™, published by the American Academy of Pediatrics makes a suggestion for an alternative treatment for tetanus. The antibiotic, metronidazole (30 mg/kg/day) given at 6 -- hour intervals is effective in reducing the bacterial count in a wound.
Metronidazole is the antibiotic of choice for dirty wounds. Another choice is injectible penicillin G (100 000 U/kg/day), given at 4 -- to 6 -- hour intervals. These therapies should be continued for 10 to 14 days.[14] It appears that a prophylactic course of antibiotics would be prudent for dirty wounds to prevent the possibility of C. tetani germination and toxin production.
Additionally, there is an antibiotic treatment available for diphtheria infections. Erythromycin orally or by injection (40 mg/kg/day; maximum, 2 gm/day) or procaine penicillin G daily, intramuscularly (300,000 U/day for those weighing 10 kg or less and 600,000 U/day for those weighing more than 10 kg) can be given for 14 days. The disease is usually not contagious 48 hours after antibiotics are instituted.
Elimination of the organism should be documented by two consecutive negative throat cultures after therapy is completed.[15] Indeed, since nearly every sore throat is treated by conventional medicine with an antibiotic, perhaps this is the reason for the decreased the incidence of diphtheria, and not the vaccine.
A third option is to use the TIG vaccine at the time of acute injury. It appears that treatment with TIG is an adequate form of treatment. The package insert states the following:
"If a contraindication to using tetanus toxoid preparations exists for a person who has not completed a primary series of tetanus toxoid immunization and that person has a wound that is neither clean nor minor, only passive immunization should be given using tetanus immune globulin."[16]
With all of these options available, routinely vaccinating adults to maintain an arbitrary antibody level should be considered inappropriate healthcare. In addition, knowing the real facts about these infections and being aware of the available treatment options should be a comfort to parents who choose not to vaccine.