*Post-injury antimicrobial agents are recommended to prevent early post-traumatic infectious complications, including sepsis, secondary to common bacterial flora. Selection is based on narrowest spectrum and duration required to prevent early infections prior to adequate surgical wound management. This narrow spectrum is selected to avoid selection of resistant bacteria. The antimicrobials listed are not intended for use in established infections, where multidrug-resistant (MDR) or other nosocomial pathogens may be causing infection.

†Cefazolin may be dosed based on body mass: 1 gram if weight < 80 kg (176 lbs), 2 grams if weight 81-160 kg (177-352 lbs), 3 grams if weight > 160 kg (>352 lbs); doses up to 12 grams daily are supported by FDA-approved package insert.

‡Pediatric dosing: cefazolin, 20-30 mg/kg IV q6-8h (maximum, 100 mg/kg/day); metronidazole, 7.5 mg/kg IV q6h; clindamycin 25-40mg/kg/day IV divided q6- 8h; ertapenem, 15 mg/kg IV or IM q12 (children up to 12 years) or 20 mg/kg IV or IM once daily (children over 12 years; maximum, 1 gm/day); ceftriaxone, 100 mg/kg/day IV divided q12-24h (dosing for CNS injury); levofloxacin, 8 mg/kg IV or PO q12h (levofloxacin is only FDA-approved in children for prophylaxis of inhalational anthrax in children > 6 months of age, but this dose is commonly used for other indications); vancomycin 60 mg/kg/day IV divided q6h (dosing for CNS injury); ciprofloxacin, 10mg/kg IV (or 10-20mg/kg PO) q12h.

- These guidelines do not advocate adding enhanced Gram negative bacteria coverage (i.e., addition of fluoroquinolone or aminoglycoside antimicrobials) in type III fractures.

**Mafenide acetate is contraindicated in infants less than 2 months of age.

††Post-injury antimicrobial therapy as suggested by the Acute Traumatic Wound Management in the Prolonged Field Care Setting CPG.