Antibiotics in TCCC 2002

## Antibiotics in Tactical Combat Casualty Care 2002

MAJ Kevin O'Connor, MC USA; CAPT Frank Butler, MC USN

Military Medicine. 168. 11:911. 2003

#### Description with Key Points

Care of casualties in the tactical combat environment should include the use of prophylactic antibiotics for all open wounds. This article recommends that oral gatifloxacin should be the antibiotic of choice because of its ease of carriage and administration, excellent spectrum of action and relatively mild side effect profile. Moxifloxacin and gatifloxacin are both fourth-generation fluoroquinolones that have an enhanced spectrum of activity and are given as a single daily 400-mg dose. Based on their similarities, either moxifloxacin or gatifloxacin would be a good choice for an oral antibiotic to use on the battlefield. Since gatifloxacin was removed from the market by the FDA in 2008, moxifloxacin is the oral antibiotic of choice for battlefield casualties with open wounds.

For those casualties unable to take oral antibiotics because of unconsciousness, penetrating abdominal trauma, or shock, intravenous cefotetan is recommended because of its longer duration of action than cefoxitin. Whereas cefoxitin and cefotetan appear to be equal in efficacy, the longer half-life and comparable cost make cefotetan a better choice for use by combat corpsmen and medics. Cefoxitin remains a viable alternative and a good second choice.

Antibiotics in Tactical Combat Casualty Care 2002
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## Take Home Message

Prophylactic antibiotics should be used by combat medical personnel for all open combat wounds.
Where there is no contraindication to the use of oral antibiotics, give moxifloxacin 400 mg. by mouth once a day.
Moxifloxacin is a broad-spectrum antibiotic that kills most bacteria and has few side effects.
Delays in antibiotic administration increase the risk of wound infections.
If unable to take oral medications (shock, unconscious, or penetrating abdominal injury), this article recommends cefotetan. 2 gm intravenously (slow push over 3-5 minutes) or intramuscularly every 12 hours.
NOTE: Cefotetan has been difficult to obtain through supply channels, resulting in the recommendation of Ertapenem 1 gm IV/IM once a day by the TCCC community.