Page 92 - JSOM Winter 2025

Proposed New Wording in the TCCC Guidelines evaluating these effects at new MTFs, similar to the data being
(changes in bolded italics) collected from the ongoing conflict in Ukraine.
9. Penetrating Eye Trauma
a. If a penetrating eye injury is noted or suspected: Lastly, more studies on the validity and impact of self-reported
• Perform a rapid field test of visual acuity and docu- and charted penicillin allergies at the time of military recruit-
ment findings. ment and beyond with the ultimate goal of allergy delabeling
• Cover the eye with a rigid eye shield (NOT a pressure can have significant downstream effects on the safety of the
patch). warfighter.
• Administer ceftriaxone 2g IV or IM (recommended),
or cephalexin 500mg or cefadroxil 1g orally as soon Disclosures
as possible. The authors have the following disclosures:
12. Antibiotics CAPT (Ret) Butler is the President of DSO Medical Associates,
a. Antibiotics recommended for all open combat an LLC that provides medicolegal consultation on diving and
wounds and invasive procedures Special Operations medical issues. He is also the first author
b. If able to take PO medications: of “Tell Them Yourself – It’s Not Your Day to Day,” a history
• Cefadroxil 1g PO once a day (recommended). of the origin and evolution of TCCC.
• Cephalexin 500mg PO four times daily (alternative).
c. If unable to take PO medications (shock, CAPT (Ret) Maves has received research support paid to his
unconsciousness): institution from AiCuris, Merck, GeoVax, and Biotest. He has
• Ceftriaxone 2g IM/IO/IV once a day. received consultancy fees from Shionogi and GSK. He receives
travel expenses and honoraria for the American Board of In-
ternal Medicine for his service as Chair, Critical Care Medicine
Results of CoTCCC Vote: Examination Approval Committee.
This proposed change was approved by the required 3/4 or
greater majority of the voting members of the CoTCCC.
Disclaimer
The views expressed in this presentation are those of the au-
Levels of Evidence thors and do not necessarily reflect the official policy or posi-
Questions 1 and 2 are graded Level A.
Questions 3 and 4 are graded Level B-NR. tion of the Department of the Navy, Department of Defense,
Defense Health Agency, nor the U.S. Government.
Considerations for Future Research and Development We are employees of the U.S. Government. This work was pre-
A promising area of future research is the use of topical an- pared as part of our official duties. Title 17 U.S.C. §105 pro-
tibiotics in combat wounds/environments. Several studies are vides that copyright protection under this title is not available
currently being conducted primarily in small special forces for any work of the United States Government. Title 17 U.S.C.
units which can ideally be applied to the TCCC environment. §101 defines a United States Government work as a work pre-
While imperfect, continued research in civilian trauma settings pared by a military service member or employee of the United
can continue to inform future avenues for military-focused States Government as part of that person’s official duties.
research.
The long-term impact of the revised antibiotic selection on Publication Clearance
resistance patterns in higher levels of care will take time to This document was reviewed by the Chief of the Joint Trauma
become evident but requires close monitoring. While some System and by the Public Affairs Office and the Operational
practices may already be established at previously utilized Security Office at the Defense Health Agency. It is approved
Military Treatment Facilities (MTFs), the emergence of new for unlimited public release.
operational theaters presents an opportunity to continue

TABLE 1 Matrix System for Determining Ideal Oral Antibiotic for Point-of-Injury Administration in TCCC
Weighted items 1 2 3 4
$/day (1) ≤10 11–40 41–70 >70
Adverse events (2) Minor, small % Minor, large % Major, small %
Half-life (3) >4 hours 3–4 hours 2–3 hours <2 hours
Drug Interactions (2) None Not clinically significant Potentially clinically significant Likely clinically significant
Clinical Experience (2) Combat trauma Trauma Deep wound/bone Skin/soft tissue
Coverage
Group A Strep (4) 1st line Alternative >70% Not reliable
MSSA (3) 1st line Alternative >70% Not reliable
Clostridia (1) 1st line Alternative >70% Not reliable
B. Fragilis (0) 1st line Alternative >70% Not reliable
MDRO (Pseudomonas 1st line Alternative >70% Not reliable
or MRSA) (0)
Stewardship (3) No concerns Minor concerns, bigger Moderate concerns, possibly Major concerns, possibly leading
impact on microbiome leading to ESBL or similar to Carbapenem Resistance

90 | JSOM Volume 25, Edition 4 / Winter 2025