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
*ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution.
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 |