ROLE OF SYSTEMIC AND TOPICAL ANTIBIOTICS

Initial antibiotic selection should avoid empiric broad spectrum coverage but rather focus on narrow spectrum antibiotics, such as first generation cephalosporins. The liberal use of topical antibiotic delivery via powder or antibiotic beads and/or Dakin’s-soaked gauze, pending available resources, is encouraged.

There is no data that supports the use of broad-spectrum antibiotics in these casualties. The most important consideration for antisepsis in the wound is adequate surgical debridement and repeated trips to the operating room. The risk with the overuse of broad-spectrum antibiotics is the development of antibiotic resistant infections. Topical antibiotics might have some efficacy, but the paucity of data does not allow for a strong recommendation.

Refer to the JTS Infection Prevention in Combat-Related Injuries CPG for further guidance.26