Intracranial injury (penetrating)
If foreign body is removed: Treat for up to 2 weeks (review iv daily).
If removal of foreign body is not feasible/possible: Discuss duration with Micro/ID, may need upto 6 weeks.
- See also Tetanus prone wounds
- Blood borne virus screen may be advised. See Blood borne virus transmission.
Preferred including penicillin allergy (non-severe)
ceftriaxone 2g iv bd AND metronidazole 400mg po tds (or 500mg iv tds if NBM)
For MRSA positive patients: ADD linezolid 600mg po bd (iv if NBM) (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with vancomycin iv
Alternative
For penicillin allergy (severe)
moxifloxacin* 400mg po od (iv if NBM) AND metronidazole 400mg po tds (or 500mg iv tds if NBM)
Moxifloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
For MRSA positive patients: ADD linezolid 600mg po bd (iv if NBM) (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with vancomycin iv
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including moxifloxacin, are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.