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 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
For penicillin allergy (non-severe)
1 month and over:
ceftriaxone iv 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.
|
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 MRSA positive patients: ADD vancomycin iv
Under 1 month: Contact Paeds ID
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
|
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 |
AND vancomycin iv
* 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
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.