Practice management guidelines for prophylactic antibiotic use in penetrating abdominal trauma

The east practice management guidelines work group

F. Luchette, A. Borzotta, Martin Croce, P. O’Neill, D. Whittmann, C. Mullins, R. Palumbo, M. Pasquale

Research output: Contribution to journalArticle

Abstract

Luchette et al. has reviewed 39 articles, which addressed prophylactic antibiotic use for trauma patients sustaining penetrating abdominal wounds. Their evidentiary review focused on mechanism of injury, choice of agent, duration of therapy, pharmacokinetics, and cost analysis. The mechanism of injury in the majority of the studies reviewed included stab wounds and gunshot wounds. In several studies, the mechanism of injury was not reported or included for nonpenetrating injuries. Thirty-three articles, which compared various antibiotics for differences in infectious complications, were reviewed. The authors concluded single and combination therapies are equally effective in minimizing trauma-related infections after penetrating abdominal wounds. Based on the evidentiary review, however, no specific antibiotic was recommended. After evaluating the duration of therapy, the authors recommend a greater than 12 hour course of antibiotics for high-risk patients. They further concluded 24 hours of prophylactic antibiotic coverage was adequate for all penetrating abdominal wounds. Prophylactic antibiotics for longer than 24 hours had no documented benefit. Most studies reviewed by the authors evaluated the efficacy of prophylactic antibiotics using standard drug doses. This is a concern when considering pharmacokinetics and patients sustaining penetrating wounds commonly suffer from abnormal perfusion and shock. When standard dosing is followed, subtheraputic levels are obtained because of reduced circulating volume. Higher doses of prophylactic antibiotics are advocated in these patients, but the ideal dose has not been established. A true cost analysis of prophylactic antibiotics needs to include hospital costs for drugs, laboratory tests, personnel time, and supplies. When these issues were all considered, the authors concluded single agent therapy that included aerobic and anaerobic coverage might be a cost-effective choice compared to traditional combination antibiotic treatments. Three evidentiary tables are included in this article. The first includes outcome studies and contains 33 articles with a conclusion section that lists antibiotic, number of patients, days of therapy, organs injured, and percent of trauma-related infections. The second table includes seven articles addressing pharmacokinetics and cost analysis. The final table contains data comparing single and combination antimicrobial agents.

Original languageEnglish (US)
JournalJournal of Trauma Nursing
Volume7
Issue number3
StatePublished - Jan 1 2000

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Practice Management
Practice Guidelines
Anti-Bacterial Agents
Wounds and Injuries
Penetrating Wounds
Costs and Cost Analysis
Pharmacokinetics
Therapeutics
Stab Wounds
Laboratory Personnel
Gunshot Wounds
Nonpenetrating Wounds
Hospital Costs
Anti-Infective Agents
Infection
Pharmaceutical Preparations
Shock
Perfusion
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Emergency
  • Critical Care
  • Advanced and Specialized Nursing

Cite this

Practice management guidelines for prophylactic antibiotic use in penetrating abdominal trauma : The east practice management guidelines work group. / Luchette, F.; Borzotta, A.; Croce, Martin; O’Neill, P.; Whittmann, D.; Mullins, C.; Palumbo, R.; Pasquale, M.

In: Journal of Trauma Nursing, Vol. 7, No. 3, 01.01.2000.

Research output: Contribution to journalArticle

Luchette, F. ; Borzotta, A. ; Croce, Martin ; O’Neill, P. ; Whittmann, D. ; Mullins, C. ; Palumbo, R. ; Pasquale, M. / Practice management guidelines for prophylactic antibiotic use in penetrating abdominal trauma : The east practice management guidelines work group. In: Journal of Trauma Nursing. 2000 ; Vol. 7, No. 3.
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