Penetrating Chest Trauma
- Treat for up to 7 days or until surgical exploration.
- If foreign body remains in situ, discuss duration of treatment with Paediatric ID.
- Review empirical treatment within 48-72 hours
Preferred
co-amoxiclav 30mg/kg (max 1.2g) iv TDS (BD if 1-2 months old)
Oral therapy (when able to tolerate): See dosing table below:
| Age | co-amoxiclav oral dose |
| 1 month to 11 months |
0.5mL/kg of 125mg/31mg/5mL suspension TDS |
| 1 year to 5 years |
10mLs of 125mg/31mg/5mL suspension TDS |
| 6 years to 11 years |
10mLs of 250mg/62mg/5mL suspension TDS |
| 12 years to 17 years | One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets |
For MRSA positive patients: ADD vancomycin iv
Alternative
For penicillin allergy (non-severe)
ceftriaxone iv for 1 month and over: 50mg/kg (max 2g) iv OD
AND metronidazole
oral dosing: 7.5 mg/kg (max 400mg) po TDS (BD if 1 month old).
for iv dosing see dosing table below.
For MRSA positive patients: ADD vancomycin iv
metronidazole IV dosing:
|
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 |
For penicillin allergy (severe)
ciprofloxacin*
oral dosing: 20mg/kg (max 750mg) po BD
for iv dosing: 10mg/kg (max 400mg) iv TDS
AND metronidazole
oral dosing: 7.5 mg/kg (max 400mg) po TDS (BD if 1 month old).
for iv dosing see dosing table below.
AND vancomycin iv
*ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
metronidazole IV dosing:
|
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 |
For high-risk cases with oesophageal perforation +/- spillage of intestinal contents into the thorax/mediastinum:
Consider adding fluconazole iv or po
| Age | fluconazole dose (iv or po) |
| 1 month and older |
6mg/kg (max 400mg) OD |
Dose can be doubled to 12mg/kg (max 400mg) OD in severe infection or if patient is immunocompromised.