Antimicrobial Prophylaxis
For antimicrobial prophylaxis advice, see Clinical Guidelines for Major Incidents and Mass Casualty Events.
All victims with injuries must have their tetanus immunisation status checked. Tetanus prophylaxis may be indicated, see also Tetanus-prone wounds.
Blood borne virus screen may be advised. See Blood borne virus transmission
These guidelines are for use in an acute mass casualty situation. Duration of antibiotics should depend on individual presentation of injuries. Oral switch or narrowing of antibiotic spectrum should occur as appropriate. Review antibiotics at earliest opportunity.
Penetrating abdominal, chest, skin and soft tissue, or bone and joint injuries
Preferred
co-amoxiclav 30mg/kg (max 1.2g) iv TDS (BD if 1-2 months old)
Penicillin allergy (non-severe)
ceftriaxone 50mg/kg (max 2g) iv OD
AND
metronidazole iv (see dosing table below)
metronidazole IV dosing:
|
Age |
metronidazole IV dose |
|
1 month upto 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 |
Penicillin allergy (severe) or MRSA positive patients
clindamycin 10mg/kg (max 600mg) iv QDS AND gentamicin 7mg/kg (max 560mg) iv OD
Penetrating CNS injuries
Penetrating CNS infection, see Penetrating intracranial injury / gunshot (= contaminated neurosurgery)
Includes:
- Contaminated, including with foreign body
- Open skull fracture
- CSF leak post skull fracture
Penetrating Eye injuries
Penetrating eye injuries: contaminated, including with foreign body, see Traumatic eye injury