Antibiotics-in-Trauma课件.ppt

《Antibiotics-in-Trauma课件.ppt》由会员分享，可在线阅读，更多相关《Antibiotics-in-Trauma课件.ppt（13页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、Antibiotics in Trauma?Tim HardcastleTrauma ServiceTygerberg Hospital/Stellenbosch UniversityIntroduction Evidence based review Rational antibiotic use in trauma Differentiate between:Prophylaxis(most commonly required)Therapy Propose local guidelineStatement of the problem Multitude of studies relat

2、ing to antibiotic use Use different drugs and doses Seldom use placebo as control Most are studies in“delayed”presentationWhat does the evidence reveal?Grading according to the“Sacket criteria”Level one evidence should be standard of care Level two evidence strongly advised as a guideline Level thre

3、e optional clinician choiceFractures Two types of fracture:open vs.closed Two types of management Closed reduction and POP ORIF Which antibiotics and how long therapy?Is there a difference in fracture severityFractures Open fractures Any patient with metalwork Grade 1&2 maximum 24 hours(Level 1)Firs

4、t generation cephalosporin As soon as possible Grade 3(Level 1&2)Cephazolin 1 or 2g alone X 72 hours or wound cover Add gram negative and anaerobe cover if severe contamination Practice management guidelinesBase of skull fractures No evidence to support routine antibiotic prophylaxis or empiric ther

5、apy in cases without meningitis Irrespective of CSF leak Other open skull fractures treat as open fractureCochrane database systemic review25 January 2006Penetrating Abdominal Trauma Repeat dose every 10 PC with major trauma(Level 3)No need for routine Metronidazole Avoid aminoglycosides(Level 3)Practice guidelines 2002Sganga,Journal of Hospital Infection 2001Vascular injuries Level 2 evidence Single dose of 1st generation cephalosporin.24 hours if synthetic graft used Single dose in endovascular proceduresDSTC Manual:Ed.K D Boffard