Bomb blast injuries in children: antibiotic management

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This guidance is adapted from Public Health England guidance (issued May 2017) and is intended for ED use. Further advice on ongoing antibiotic management may be provided by microbiology if required. In addition to antibiotics, tetanus and BBV exposure should be considered:

Tetanus immunisation

ALL bomb blast victims with injuries must have their tetanus immunisation status checked and treated according to the extant advice on management of patients with tetanus prone wounds in the ‘Green Book’  

Hepatitis B vaccination

ALL patients who sustained injuries that breached skin must receive an accelerated course of Hepatitis B vaccination (0, 1, and 2 months, or, day 0, day 7, day 21 and at 12 months). Patients who are discharged from inpatient care before completion of an accelerated hepatitis B vaccination course should receive remaining doses of vaccine either at out-patient follow up, or by arrangement with their GP ALL patients should be tested at 3 months to determine their hepatitis B vaccine response and at 3 months and 6 months to determine their hepatitis C and HIV status.

Post exposure prophylaxis for HIV

HIV PEP is not usually required. Discuss with ID on call if uncertain.

Emergency Department Paediatric Antibiotic Management of Bomb Blast Injuries

Injury

Antibiotic prophylaxis  (see appendix for doses)

Soft tissue injury

 

(No foreign body in situ)

IV co amoxiclav  

Penicillin allergy: IV Clindamycin and gentamicin 

Continue IV treatment until first surgical debridement/washout 

Then switch to oral co-amoxiclav

Penicillin allergy: oral Clindamycin and ciprofloxacin 

Duration: 3 days

Soft tissue injury

(Foreign body in situ)

IV co amoxiclav 

Penicillin allergy: IV Clindamycin and gentamicin

Continue IV treatment until first surgical debridement/washout and removal of foreign body

Then switch to oral co-amoxiclav (dose as per BNF for Children)

Penicillin allergy: oral clindamycin and ciprofloxacin

Duration: 7 days

If foreign body remains in situ, consult microbiology re duration of treatment

Open Fractures

Or

‘Through and through’ fractures

Or

Intra-articular injuries

IV co amoxiclav 

Penicillin allergy: Clindamycin and gentamicin

Continue IV antibiotics until soft tissue closure or for a maximum of 72 hours.

Prolonged oral therapy may be required after this, please seek advice from microbiology.

Penetrating CNS injury

IV Ceftriaxone and IV metronidazole (switch to oral when able to swallow

Duration: 2 weeks if foreign body removed. 

                  6 weeks if foreign body still in situ

Open skull fracture from penetrating trauma

IV Ceftriaxone 100mg/kg once daily

Discuss duration of IV therapy and oral switch with microbiology

CSF leak post skull fracture

No antibiotics required

Give Pneumovax

Penetrating eye injury

Oral Ciprofloxacin and oral clindamycin (use IV route if oral route compromised) and 

topical chloramphenicol, 0.5% drops every 2 hours and 1% eye ointment at night

Duration: 2 weeks if foreign body removed                                                            

Seek advice from microbiology re duration if foreign body remains in situ

Internal ear injury

Keep clean and dry. Urgent referral to ENT for examination and removal of debris/clots and instillation of antibiotic ear drops if required.

Penetrating abdominal injury or chest trauma

IV co-amoxiclav

Penicillin allergy: Clindamycin and gentamicin

Add fluconazole if any spillage of gastrointestinal contents or perforation

(review regularly with microbiology)

Switch to oral co-amoxiclav

Penicillin allergy: <TR VALIGN=TOP>  Clindamycin and ciprofloxacin

Duration: 7 days

Appendix: drug doses

Drug

Route

Dose

Ceftriaxone

IV

100mg/kg once a day

Ciprofloxacin

IV

10mg/kg (max 400mg) every 8 hours

Oral 

20mg/kg (max 750mg) twice a day

Clindamycin

IV

10mg/kg every 6 hours

Oral 

6mg/kg (max 450mg) four times a day

Co-amoxiclav

IV

1 – 2 months 30mg/kg every 12 hours

3 months – 18 years 30mg/kg every 8 hours

oral

1-11 months: 125/31 suspension, 0.25ml/kg three times a day

1 – 5 years: 125/31 suspension, 5ml three times a day

6 – 11 years: 250/62 suspension, 5ml three times a day 12 – 17 years : 250/125mg tablet, 1 three times a day

Gentamicin

IV

7mg/kg once a day (check levels as per local policy)

Metronidazole

IV

7.5mg/kg (max 500mg) 8 hourly 

Editorial Information

Last reviewed: 17 November 2017

Next review: 30 November 2020

Author(s): Ysobel Gourlay

Approved By: Antimicrobial Utilisation Committee