Page 93 - JSOM Winter 2025

TABLE 2 Matrix System for Determining Ideal Parenteral Antibiotic for Point-of-Injury Administration in TCCC
Antimicrobial Coverage
MDRO
Adverse Drug Clinical Group B. (PsA or
$/dose events Half-life interactions experience A Strep MSSA Clostridia fragilis MRSA) Stewardship Weighted
Antibiotic [1] [2] [3] [2] [2] [4] [3] [1] [0] [0] [3] score
Amoxicillin / 0.01 Minor (i.e., 1 hr None Combat Yes Alt. Alt. Yes Not Minor 39
clavulanate (1) diarrhea) (4) (1) trauma (1) (2) (2) (1) reliable concerns
>10% of (1) (4) (2)
population
(2)
Cefadroxil 6.00 Minor (i.e., 1–2 hr None Deep Yes Yes Not Not Not No concerns 37
(1) diarrhea) (4) (1) Wound/ (1) (1) reliable reliable reliable (1)
<10% of bone (4) (4) (4)
population (3)
(1)
Cephalexin 0.15 Minor GI 0.5–1 hr None Deep Yes Yes Not Not Not No concerns 37
(1) discomfort (4) (1) Wound/ (1) (1) reliable reliable reliable (1)
<10% of bone (4) (4) (4)
population (3)
(1)
Dicloxacillin 0.60 Minor 45 min None Skin/soft Yes Yes Not Not Not No concerns 39
(1) reactions (4) (1) tissue (1) (1) reliable reliable reliable (1)
<10% of (4) (4) (4) (4)
population
(1)
Linezolid 15.95 Minor (i.e., 5 hrs Not clinically Deep Yes Alt. Alt. Not Yes, Minor 37
(2) diarrhea) (1) significant Wound/ (1) (2) (2) reliable MRSA concerns
>10% of interaction bone (4) (1) (2)
population with fentanyl (3)
(2) (2)
Moxifloxacin 17.80 Minor ~12 hrs Not clinically Combat Alt. Alt. Not >70% Not Moderate 42
(2) reactions (1) significant trauma (2) (2) reliable (3) reliable concerns
>10% of (2) (1) (4) (4) (3)
population
(2)

TABLE 3 Characterization of Oral Antimicrobial Agents for Point-of-Injury Administration in TCCC
Weighted items 1 2 3 4
$/day (1) ≤10 11–40 41–70 >70
Mixture (2) Vial, <3mL Vial, <5mL reconstitute Vial, <10mL Premix >10mL
reconstitute reconstitute
Infusion time (2) ≤5 6–30min 31–60min >60 min
Administration (IV/IM) (2) Both IV push IV infusion
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 Potentially clinically Likely clinically
significant significant significant
Clinicalexperience (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 or 1st line Alternative >70% Not reliable
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
Note “[x]” in column headers refers to weight of that category in calculating the final Weighted Score; “(x)” within the body of the table refers
to the category’s score based on Table 1. Lower weighted scores are considered more favorable.

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