Antimicrobial Prophylaxis
For antimicrobial prophylaxis advice see Clinical Guidelines for Major Incidents and Mass Casualty Events.
All victims with injuries must have their tetanus immunisation status checked. Tetanus prophylaxis may be indicated. See Tetanus prone wounds.
Blood borne virus screen may be advised. See Blood borne virus transmission.
These guidelines are for use in an acute mass casualty situation. Duration of antibiotics should depend on individual presentation of injuries. Oral switch or narrowing of antibiotic spectrum should occur as appropriate. Review antibiotics at earliest opportunity.
Penetrating abdominal, chest, skin and soft tissue, or bone and joint injuries
Preferred
co-amoxiclav 1.2g iv tds AND metronidazole 400mg po tds (or 500mg iv tds if NBM).
Penicillin allergy (non-severe)
cefazolin 2g iv tds AND metronidazole 400mg po tds (or 500mg iv tds if NBM).
Penicillin allergy (severe) or for MRSA positive patients
teicoplanin iv 6mg/kg (See teicoplanin monograph for dose banding, dose frequency and monitoring).
AND metronidazole 400mg po tds (or 500mg iv tds if NBM)
AND gentamicin* 5mg/kg iv (Gentamicin is for maximum of 3 days)
*Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
Penetrating CNS injuries
For penetrating CNS infection, see Intracranial injury (penetrating) / gunshot
Includes:
- Contaminated, including with foreign body.
- Open skull fracture.
- CSF leak post skull fracture.
Penetrating eye injuries
For penetrating eye injuries, see Traumatic eye injury
Includes:
- Contaminated, including with foreign body
References
Public Health England, University Hospitals Birmingham NHS Foundation Trust. Clinical Guidelines for Major Incidents and Mass Casualty Events. Published September 2022. Available at: B0128-clinical-guidelines-for-use-in-a-major-incident-v2-2020.pdf (england.nhs.uk). Accessed on 2023 Aug 30.