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

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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)

Prophylaxis for penetrating chest trauma, requiring chest drain insertion

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