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.
|
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: |
|
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) 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: Clindamycin and Ciprofloxacin Duration: 7 days |
|
Drug |
Route |
Dose |
|
Ceftriaxone |
IV |
100mg/kg (max 4 grams) once a day |
|
Ciprofloxacin |
IV |
10mg/kg (max 400mg) every 8 hours |
|
Oral |
20mg/kg (max 750mg) twice a day |
|
|
Clindamycin |
IV |
10mg/kg (max 1.2grams) every 6 hours |
|
Oral |
6mg/kg (max 450mg) four times a day |
|
|
Co-amoxiclav |
IV |
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 |
|
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 tab three times a day |
|
|
Gentamicin* |
IV |
7mg/kg (max 400mg) once a day TDM required - check levels as per local policy |
|
Metronidazole |
IV |
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.
Last reviewed: 17 November 2020
Next review: 31 October 2024
Author(s): Susan Kafka
Version: 2
Approved By: Antimicrobial Utilisation Committee