Page 106 - 2023 SMOG Digital

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 narrowest spectrum and duration required to prevent early infections prior to adequate surgical wound
management. This narrow spectrum is selected to avoid selection of resistant bacteria. The antimicrobials listed are not intended for use in established
infections, where multidrug-resistant (MDR) or other nosocomial pathogens may be causing infection.
Injury Preferred Agent Frequency Duration
Extremity Wounds (Includes Skin, Soft Tissue, and Bone)
Cefazolin 1-2g q6-8hr
Skin, soft tissue, without open fractures Or 24 hours
Ertapenem 1g x 1 dose
Cefazolin 1-2g q6-8hr 24 hours, then with each
Skin, soft tissue, with open fractures, exposed bone, or open
joints Or subsequent I&D until soft
Ertapenem 1g x 1 dose tissue coverage
Thoracic Wounds
Cefazolin 1-2g q6-8hr
Penetrating chest injury Or 24 hours
Ertapenem 1g x 1 dose
Cefazolin 1- 2g q6-8hr
Penetrating chest injury with esophageal disruption PLUS metronidazole 500mg IV q8-12hr Stop 24 hours after
Or
definitive closure
Ertapenem 1g x 1 dose
Abdominal Wounds
Penetrating abdominal injury with Cefazolin, 1-2g IV q6-8hr Stop 24 hours after
suspected/known hollow viscus injury and soilage; may apply PLUS metronidazole 500mg IV q8-12hr control of
Or
to rectal/perineal injuries as well contamination
Ertapenem 1g x 1 dose
Maxillofacial And Neck Wound
Cefazolin 1-2g q6-8hr
Open maxillofacial fractures, maxillofacial fractures with Or 24 hours
foreign body or fixation device Ertapenem 1g x 1 dose
Central Nervous System Wounds
Cefazolin 1-2g IV q6-8hr 5 days or until CSF
Penetrating brain injury Or leak is closed,
Ertapenem 1g x 1 dose whichever is longer
Cefazolin 1-2g IV; q6-8hr 5 days or until CSF
Penetrating brain injury with gross Consider metronidazole 500mg IV q8-12hr leak is closed,
contamination with organic debris Or whichever is longer
Ertapenem 1g x 1 dose
Cefazolin 1-2g IV q6-8hr 5 days or until CSF
Penetrating spinal cord injury Or leak is closed,
Ertapenem 1g x 1 dose whichever is longer
Cefazolin, 1-2g IV q6-8hr 5 days or until CSF
Penetrating spinal cord injury with abdominal cavity is PLUS metronidazole 500mg IV q8-12hr leak is closed,
involvement Or
Ertapenem 1g x 1 dose whichever is longer
Eye Wounds
Erythromycin ophthalmic ointment q6hr Until epithelium healed.
Eye injury, burn or abrasion Or or prn for No systemic treatment
Bacitracin ophthalmic ointment symptomatic required
relief
Levofloxacin 750mg IV/PO q24 hr
PLUS vancomycin 15-20mg/kg IV or q8-12hr 7 days or until evaluated
Eye injury, penetrating Moxifloxacin 400mg IV/PO once daily by an ophthalmologist.
q24hr No topical agents.
Burns
Topical antimicrobials q24hr
(mafenide acetate or silver sulfadiazine)
Superficial burns OR Until healed
silver impregnated dressing, q3-5d
PLUS excision and grafting
Topical antimicrobials q24hr
(mafenide acetate or silver sulfadiazine)
Deep partial thickness burns OR Until healed or grafted
silver impregnated dressing, q3-5d
PLUS excision and grafting
Topical antimicrobials
Full thickness burns PLUS excision and grafting q24hr Until healed or grafted
Delayed Evacuation to Surgical Care
PO tolerable Moxifloxacin 400 mg PO x1 dose. X 1 dose
Or Single dose therapy
Not PO tolerable Ertapenem 1g IV/IM X 1 dose
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