Duration of Preventive Antibiotic Administration for Penetrating Abdominal Trauma

Current Management of Colon Trauma

“…Early studies by Rowlands et al [95] and Griswold et al [96] advocated extended periods of antibiotic coverage (5 days), but the studies lacked a good design and have subsequently been outdated by better studies. In randomized prospective trials, Oreskovich et al [97] and Dellinger et al [98] reported no difference in the infectious complication rate (including intraabdominal abscesses) when antibiotics were given for 12 hours or 5 days. In a prospective randomized blinded trial, Fabian et al [99] found similar rates of major abdominal infection (MAI) when colon wounds were treated for 24 hours or 5 days with antibiotics.…”

Antibiotic prophylaxis in trauma: Global Alliance for Infection in Surgery, Surgical Infection Society Europe, World Surgical Infection Society, American Association for the Surgery of Trauma, and World Society of Emergency Surgery guidelines

“…Antibiotic prophylaxis should be given in penetrating trauma, but it should not last more than 24 hours in the absence of hollow viscus injuries; broad-spectrum antibiotics with aerobic and anaerobic bacteria coverage should be preferred, while aminoglycosides should be avoided whenever possible. In the case of hemorrhagic shock and associated acute kidney injury, the dose of antibiotics should be adjusted 66–95 . Hollow viscus injury with contamination should be considered an indication for antibiotic therapy rather than AP.…”

Surgical Infection Society—Trials and Tribulations

“…A useful strategy is to define an important clinical question, then to look for a relevant new drug that is in the stage of its commercial life when industry usually funds clinical trials, and then propose to the parent company a trial that uses their drug in a setting that allows the important clinical question to be addressed. This strategy, for instance, has been used to test the hypotheses that a short course of presumptive antibiotics would be equivalent to a long course in the treatment of contaminated traumatic wounds [24][25][26][27] and that antibiotic activity against anaerobic bacteria was important in the treatment of intra-abdominal infection. 28 Not all clinical questions of interest can be posed directly with a new drug trial, but many can.…”