Penetrating intracranial injury / gunshot - contaminated neurosurgery
Give antibiotics for 5 days post-operatively and review with Paediatric ID for decision on total antibiotic duration.
See also Tetanus-prone wounds.
Preferred including non-severe penicillin allergy
ceftriaxone 80mg/kg (Max 4g) iv OD
AND metronidazole iv (see dosing table below) OR if tolerating oral medication metronidazole po (see dosing table below)
metronidazole IV dosing information:
|
Age |
metronidazole IV dose |
|
1 month up to 2 months |
Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS |
|
2 months to 17 years |
7.5mg/kg (Max 500mg) iv TDS |
metronidazole ORAL dosing information:
| Age | metronidazole oral dose |
| 1 month | 7.5 mg/kg (max 400mg) po BD |
| 2 months-11 years | 7.5 mg/kg (max 400mg) po TDS |
| 12 years and older | 400mg po TDS |
For penicillin allergy (severe) or MRSA positive
ciprofloxacin* 10mg/kg (max 400mg) iv TDS OR if tolerating oral medication ciprofloxacin* 20mg/kg (Max 750mg) po BD
AND metronidazole iv (see dosing table below) OR if tolerating oral medication metronidazole po (see dosing table below).
AND vancomycin iv
metronidazole IV dosing information:
|
Age |
metronidazole IV dose |
|
1 month up to 2 months |
Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS |
|
2 months to 17 years |
7.5mg/kg (Max 500mg) iv TDS |
metronidazole ORAL dosing information:
| Age | metronidazole oral dose |
| 1 month | 7.5 mg/kg (max 400mg) po BD |
| 2 months-11 years | 7.5 mg/kg (max 400mg) po TDS |
| 12 years and older | 400mg po TDS |
* Note: Ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution.
Also Note: If patient is prescribed ciprofloxacin ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.
For more information about MHRA safety alerts and patient or carer counselling See Fluoroquinolone antibiotics - paediatric position statement