- Antimicrobial drug usage contributes to the development of multidrug-resistant organisms. Use of overly broad antibiotics for combat trauma prophylaxis has resulted in an increased risk of MDRO infection without improvement in long-term clinical outcomes such as number of surgical procedures, length of hospitalization, or osteomyelitis.12,13
- All facilities should avoid unnecessary empiric use of broad spectrum antibiotics.
- When available, use local antibiogram to guide empiric therapy.
- Limit duration of antibiotic therapy. Several well-controlled studies have shown benefit to shorter courses of antibiotic therapy for common infectious problems (for example, pneumonia.). Prolonged duration of prophylaxis has not been shown to decrease long term rates of infections in retrospective study of 1,044 patients with combat-related open fractures.12 The shortest course of post-injury antimicrobial therapy should be used.
- Appendix B: Post-Injury Antimicrobial Agent Selection and Duration describes antimicrobial prophylaxis regimens and proposed durations for combat wounded personnel.