Adult

Penetrating Chest Trauma

  • For complex trauma cases or if foreign body remains in situ, discuss duration of treatment with Micro/ID.
  • Tetanus prophylaxis/ vaccination may be indicated, see also Tetanus prone wounds 
  • For chest trauma caused by a Mass Casualty Event, including bomb blasts, see  Antimicrobial Prophylaxis

Prophylaxis for penetrating chest trauma, requiring chest drain insertion

Preferred (including penicillin allergy (non-severe))

cefazolin 1g iv tds for 24 hours following chest drain insertion 

 

If contaminated by soil or excreta: ADD metronidazole 400mg po tds (or 500mg iv tds if NBM) 

 

For penicillin allergy (severe) AND/OR for MRSA positive patients

co-trimoxazole 960mg po bd (or iv if NBM) for 24 hours following chest drain insertion  

 

For high risk-cases with oesophageal perforation +/- spillage of intestinal contents into thorax/mediastinum: consider ADDING fluconazole 400mg po od (or iv if NBM) 

Editorial Information

Last reviewed: 01 Jul 2024

References
  1. Butler J, Sammy I, Desmond J, et al Antibiotics in patients with isolated chest trauma requiring chest drains. Emergency Medicine Journal 2002;19:553-554.
  2. Yuan, KC., Huang, HC. Antimicrobial Prophylaxis in Patients with Major Trauma. Curr Trauma Rep 3, 292–299 (2017). https://doi.org/10.1007/s40719-017-0104-0