Penetrating Brain and Spinal Injury

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Penetrating Spinal Injury

Prophylactic antibiotic treatment is only indicated in cases of penetrating spinal injury with concomitant gastrointestinal organ injury/violation, particularly colonic injuries or in cases of frank contamination. 

First line treatment

  • Vancomycin 15mg/kg every 12 hours* plus Metronidazole 500 IV every 8 hours plus Ceftriaxone 2g IV every 12 hours

Penicillin alternative

  • Vancomycin 15mg/kg every 12 hours* plus Metronidazole 500 IV every 8 hours plus Aztreonam 2g IV every 8 hours

Duration

  • 5-7 days
    • Length of treatment should be based on type of wound and degree of contamination.
    • Some institutions recommend longer treatment courses.
    • Extend treatment duration in the setting of active infection.

Notes

There is little data on which to base firm recommendation for penetrating brain or spinal injuries. However, infection in this population is not uncommon and carries significant morbidity. Many institutions treat empirically, although studies to support an exact regimen and duration of treatment do not exist. The most commonly suggested regimen is listed above, however any combination adequately covering gram positive, gram negative and anaerobic pathogens is reasonable. 

*Every Vancomycin order requires pharmacokinetic consult.

 

Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.