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Bomb blast injuries in children: antibiotic management

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November 2023: This guidance is currently under review as it has gone beyond the standard review date. It reflects best practice at the time of authorship / last review and remains safe for use. If there are any concerns regarding the content then please consult with senior clinical staff to confirm.

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.

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 the relevant immunisation provider.

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


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


‘Through and through’ fractures


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

2 weeks if foreign body removed. 
6 weeks if foreign body still in situ

Open skull fracture from penetrating trauma

IV Ceftriaxone 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) 


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: Clindamycin and Ciprofloxacin

Duration: 7 days

Appendix: drug doses






100mg/kg (max 4 grams) once a day



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


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



10mg/kg (max 1.2grams) every 6 hours


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



1 – 2 months 30mg/kg (max 1.2 grams) every 12 hours

3 months – 18 years 30mg/kg (max 1.2 grams) every 8 hours


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 tab three times a day



7mg/kg (max 400mg) once a day

TDM required - check levels as per local policy



7.5mg/kg (max 500mg) 8 hourly 

* Note - Caution should be taken when dosing gentamicin in patients who are overweight/obese. Contact Pharmacy for advice.

Editorial Information

Last reviewed: 17 November 2020

Next review: 31 October 2024

Author(s): Susan Kafka

Version: 2

Approved By: Antimicrobial Utilisation Committee