Page 103 - 2026 SMOG

ANTIBIOTIC THERAPY CHART
Post-injury antimicrobial agents are recommended to prevent early post-traumatic infectious
complications, including sepsis, secondary to common bacterial flora. Selection is based on
the narrowest spectrum and duration required to prevent early infections prior to adequate
surgical wound management. This narrow spectrum is selected to avoid the selection of resistant
bacteria. The antimicrobials listed are not intended for use in established infections, where
multidrugresistant (MDR) or other nosocomial pathogens may be causing infection.
Injury Preferred Agent Frequency Duration
Extremity Wounds
Skin, soft tissue, without open Cefazolin 2g q6–8hr 24hr
fractures
Skin, soft tissue, with open Cefazolin 2g q6–8hr 24hr, then with each
fractures, exposed bone, or subsequent I&D until
open joints soft tissue coverage
Thoracic Wounds
Penetrating chest injury Cefazolin 2g q6–8hr 24hr
Abdominal Wounds
Penetrating abdominal injury Cefazolin 2g q6–8hr Stop 24hr after control
with suspected/known hollow PLUS q6–12hr of contamination.
viscus injury and soilage; may Metronidazole
apply to rectal/perineal injuries 500mg IV
as well
Maxillofacial and Neck Wounds
Open maxillofacial fractures, Cefazolin 2g q6–8hr 24hr
maxillofacial fractures with a
foreign body or fixation device
Central Nervous System Wounds
Penetrating brain injury Cefazolin 2g IV q6–8hr 5 days or until
PLUS (consider) q6–12hr CSF leak is closed,
Metronidazole whichever is longer
500mg
Penetrating spinal cord injury Cefazolin 2g IV q6–8hr
PLUS (consider) q6–12hr
Metronidazole
500mg
(comtinues)

2026 Standard Medical Operating Guidelines (SMOG) • 95