Active immunization: toxoids
To induce active immunity in surgical practice, toxoids are traditionally used. These agents stimulate the body to independently produce defense against specific pathogens.
The key agent is staphylococcal toxoid. Its administration requires strict adherence to technique and regimen:
- Localization: injections are administered subcutaneously, strictly into the subscapular region.
- Classical regimen: the starting baseline dose is only 0.1 ml. Subsequently, the drug is administered every 2–3 days. With each successive injection, the dosage is increased by 0.1 ml, gradually bringing the total volume to 1 ml.
- Emergency prophylaxis: if a patient is scheduled for surgery and rapid protection is required, the regimen changes — 0.5 ml of the drug is administered as a single dose.
Another crucial agent is tetanus toxoid. It is used for both routine and emergency prophylaxis of tetanus in trauma and injuries. The main feature of emergency measures is that the administration of tetanus toxoid must be combined with the use of tetanus antitoxin for an immediate dual effect.
Passive immunization: sera
Unlike toxoids, passive immunization involves the administration of products that already contain preformed antibodies against specific pathogens of surgical infection. This provides immediate protection without waiting for the body's immune response.
The route of administration for such sera strictly depends on the purpose of their use:
- For prophylactic purposes, the drugs are administered exclusively intramuscularly.
- For therapeutic purposes, when massive and rapid delivery of antibodies to the infection focus is required, sera are administered intravenously.
Important: intravenous administration of foreign serum proteins is associated with a high risk of severe allergic reactions. Therefore, such procedures are performed with special precautions and readiness to manage anaphylaxis.
Immunostimulating agents
The third group of agents used by surgeons consists of immunostimulating agents. Their action is directed not at a specific pathogen, but at the general enhancement of the patient's nonspecific immunological defense. This helps tissues cope with inflammation faster and prevents the generalization of surgical infection.
Briefly: answers to topical questions
What is the exact dosage of tetanus antitoxin and tetanus toxoid for emergency prophylaxis?
The exact dosage of the drugs depends on the patient's previous vaccination history.
- Tetanus toxoid — previously vaccinated patients receive 0.5 ml, unvaccinated patients are given 1 ml.
- Tetanus antitoxin — unvaccinated patients are administered 3,000 IU in combination with the toxoid.
- As an alternative to the serum, antitetanus gamma-globulin can be used at a dose of 450–600 IU.
What specific immune sera are used for passive immunization in surgery?
For passive immunization in surgery, heterologous hyperimmune sera obtained from animal blood (horses) are used.
- Tetanus antitoxin — used for emergency prophylaxis and treatment of tetanus.
- Gas gangrene antitoxin (polyvalent) — contains specific antibodies against the main pathogens of gas gangrene (Clostridium perfringens, Cl. oedematiens, Cl. septicum, Cl. histolyticum).
Which specific immunostimulating agents are prescribed to enhance nonspecific defense in surgery?
To enhance the nonspecific resistance of the body, the following are used:
- Immunomodulators: gamma-globulin, levamisole, T-activin, thymalin, thymogen.
- Interferon preparations: alpha-interferon.
- Inducers of endogenous interferon synthesis: cycloferon, neovir, tilorone (amixin).
- Other immunostimulants: immunofan, azoximer bromide (polyoxidonium), broncho-munal, ribomunyl, prodigiosan, echinacea (immunal), galavit.
What are the rules and methods for preventing anaphylactic shock when administering foreign sera?
Prevention of anaphylactic shock requires mandatory testing for sensitivity to horse protein prior to drug administration.
- Intradermal test: 0.1 ml of diluted (1:100) serum is administered.
- Subcutaneous test: if the intradermal test is negative, 0.1 ml of undiluted serum is administered subcutaneously; if there is no reaction after 30 minutes, the entire prescribed dose is administered.
- If the test is positive: the serum is administered only under absolute indications in an intensive care unit.
- Bezredka's method: the diluted serum is administered subcutaneously in fractional doses at 20-minute intervals: 0.5 ml, 2 ml, and 5 ml.
- Additionally, preventive anti-shock therapy is used: prednisolone 240–360 mg intravenously and antihistamines.
It is easy to remember the routes of administration for sera: Prophylaxis — Simpler (intraMuscularly), Treatment — more urgent and complex (intraVenously, with the risk of allergy).
Class and exam questions
Where and how is staphylococcal toxoid properly administered?
The drug is administered subcutaneously into the subscapular region. According to the classical regimen, it starts with 0.1 ml, adding 0.1 ml every 2–3 days (up to 1 ml).
What does emergency tetanus prophylaxis entail?
In emergency cases, with high risks of wound infection, the administration of tetanus toxoid is combined with tetanus antitoxin.
Why is intravenous administration of sera dangerous?
Intravenous administration of preformed sera carries a high risk of acute allergic reactions, and therefore it is used only for therapeutic purposes under strict precautions.
What else to study on this topic
- Mechanisms of allergic reactions to serum administration
- Protocols for routine tetanus prophylaxis in surgery
- Features of nonspecific immunological defense in surgical patients
- Interaction of toxoid and serum when administered together
- Criteria for choosing between prophylactic and therapeutic use of antibodies
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