Gunshot or other trauma preventative antibiotics

[tmckay2]

This came up while discussing first aid. If you go into the back country and have a risk of gunshot wound or other puncture or tearing trauma you may want to add antibiotics to your trauma kit along with gauze and clotting substances.

My professional but still offhand recommendation is to look at getting cephalexin, levofloxacin or ciprofloxacin and metronidazole. You can probably get these through the fish places. If the wound is to an extremity, taking one to two tablets or capsules of cephalexin will probably be effective enough. Generally 1-2 days should be enough time to prevent infection from typical skin and hair microbes that get dragged into the wound until you can get help. If the wound occurs center mass or particularly in the gut, levofloxacin and metronidazole once daily will probably be sufficient to prevent infection from gut flora. Cipro is another option but has significant resistance in some areas. You can use treatment doses of antibiotics but will increase side effects, often GI related which could be a risk if significant bleeding and this dehydration has occurred. Often once daily dosing will be sufficient to prevent growth.

Anyways, just my two cents if that's a scenario you may run into at some point.

[tmckay2]

Keep in mind that wounds to te gut could compromise the ability to absorb the drug orally depending where the injury is. In those cases be extra careful to ensure the wound is clean and is not being infected with outside material. Help needs be reached ASAP in these cases as infection is likely and you have no means to adequately feed or give medication.

[rondog]

A small bottle of colloidal silver to flush the wound with isn't a bad idea either. Also good on a dressing.

[cmailliard]

Here is the TCCC Guideline:

Tactical Field Care

15. Antibiotics: recommended for all open combat wounds
a. If able to take PO:
- Moxifloxacin, 400 mg PO one a day

On a side note my daughter had a horrible ear infection and Moxi was the only that would touch it.

[Fentonite]

For severe extremity injuries, i.e., open fractures of military/combat etiologies (not just routine civilian injuries), I'd prefer something with some gram-negative coverage as well. Cephalexin is ok, but no gram-neg coverage. Current recommendations would be something along the lines of cefuroxime, which has both gram-pos and gram-neg coverage. If concerned for MRSA, you'd need to add another agent, such as Bactrim or doxy, depending on local resistance patterns.

I agree that levofloxacin and metronidazole are fine for gut injuries, but certainly, IV would be a preferable route to oral, if at all possible.

[tmckay2]

You can get gram negative coverage by using a broader agent but in most cases it won't be necessary although it depends on whether you were infected from the object, from post contamination or from your own flora which was what I was covering for. Beta lantana and first gen cephalosporins won't cover everything but it will cover the most likely culprits. And yes iv would be preferred in gut wounds but obviously that isn't an option. Mrsa is a separate issue altogether but it is unlikely you will get it out in the back country, even if you yourself are a health care worker. Certainly I wouldn't argue that bactrim and doxy aren't good to have anyway but I just don't think it's likely you'll need it.

Moxi for trauma? That's bizarre. That's a respiratory FQ and generally is only reserved for respiratory infections.

For severe extremity injuries, i.e., open fractures of military/combat etiologies (not just routine civilian injuries), I'd prefer something with some gram-negative coverage as well. Cephalexin is ok, but no gram-neg coverage. Current recommendations would be something along the lines of cefuroxime, which has both gram-pos and gram-neg coverage. If concerned for MRSA, you'd need to add another agent, such as Bactrim or doxy, depending on local resistance patterns.

I agree that levofloxacin and metronidazole are fine for gut injuries, but certainly, IV would be a preferable route to oral, if at all possible.

[Fentonite]

You can get gram negative coverage by using a broader agent but in most cases it won't be necessary although it depends on whether you were infected from the object, from post contamination or from your own flora which was what I was covering for.

For most "civilian" wounds, I would agree with you. However, combat-related wounds have a higher incidence of soil and vegetation contaminants, and should be prophylaxed accordingly. Just my two cents.

[tmckay2]

For most "civilian" wounds, I would agree with you. However, combat-related wounds have a higher incidence of soil and vegetation contaminants, and should be prophylaxed accordingly (i.e., to cover aerobic gram-neg bacilli). Just my two cents.

True, vegetation could increase the chances on gram negative infections.

[Omicron]

As far as keeping antibiotics in your trauma kit, don't they have a relatively short half life, and become much less effective as they age? As I recall, the full strength life is about 2 years on most antibiotics. This being the case, you'll want to figure out a way to rotate fresh supplies into your kit as they age.

Secondly, is it a good idea to only take 1-2 days course of antibiotics? My understanding is that you need to take 5-7 days worth once you start them, or your partially kill the infection and run the risk of making whatever survives resistant to that particular antibiotic.

[hollohas]

I already carry a clotting agent and gauze etc, but it's a good idea to carry antibiotics. So, great post, but I don't understand what you guys are saying beyond that.

You guys debate what's best in your fancy medical terms and then tell me what I should buy or ask my doctor for.