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ã Copyright Eastern Association for the Surgery
of Trauma, 1998 Practice
Management Guideline
Parameters for Prophylactic
Antibiotics in Tube Thoracostomy for Traumatic
Hemopneumothorax
PROPHYLACTIC
ANTIBIOTICS IN TRAUMA PATIENTS WITH TUBE THORACOSTOMY
LITERATURE REVIEW
First Author
|
Year
|
Reference
|
Data
Class
|
Conclusions
|
Antibiotic
|
#
Pts.
|
Duration
|
Pneumonia
|
Empyema
|
| Grover FL |
1977
|
Prophylactic antibiotics in
the treatment of penetrating chest wounds: A
prospective double-blinded study. J Thor Cardio
Surg 74: 528
|
I
|
Clindamycin
Placebo
|
38
37
|
1-5 days
N/A
|
10.5%
35.1%
|
2.6%
16%
|
| Stone HH |
1981
|
Cefamandole for prophylaxis
against infection in closed tube thoracostomy. J Trauma
21: 975
|
I
|
Placebo
Cefamandole
|
60
60
|
48 hours
after
CT d/ced
_ 6 days
|
5%
0%
|
8.3%
1.7%
|
| LeBlanc KA |
1985
|
Prophylactic antibiotics and
closed tube thoracostomy. S,G&O
160: 259
|
II
|
Cephapirin
Placebo
|
39
46
|
24 hours
after
CT d/ced
|
2.6%
2.2%
|
0%
2.2%
|
| Mandal AK |
1985
|
Prophylactic antibiotics and
no antibiotics compared in penetrating chest
trauma. J Trauma
25: 639
|
II
|
Doxycycline
Placebo
|
40
40
|
Until CT
removed
|
0%
2.5%
|
0%
0%
|
| LoCurto JJ, Jr. |
1986
|
Tube thoracostomy and
trauma--Antibiotics or not? J Trauma
26: 1067
|
II
|
Placebo
Cefoxitin
|
28
30
|
12 hours
after
CT
d/ced
|
14%
3%
|
18%
0%
|
| Brunner RG |
1990
|
The role of antibiotic
therapy in the prevention of empyema in patients
with an isolated chest injury (ISS 9-10): A
prospective study. J Trauma
30: 1148
|
II
|
No antibiotics
Cefazolin
|
46
44
|
until CT
removed
|
6.5%
2.3%
|
13%
0%
|
| Demetriades D |
1991
|
Antibiotic prophylaxis in
penetrating injuries of the chest. Ann R Coll Surg
Engl 73: 348
|
II
|
Ampicillin IV
prior
to tube insertion
|
95
93
|
Pre-tube
insertion
Oral
until CT d/ced
|
3.1%
2.1%
|
0%
1.1%
|
| Nichols RL |
1994
|
Preventive antibiotic usage
in traumatic thoracic injuries requiring closed
tube thoracostomy. Chest
106: 1493
|
I
|
Cefonicid
Placebo
|
63
56
|
Until CT
removed
|
0%
5%
|
0%
7%
|
| Fallon WF Jr. |
1992
|
Prophylactic antibiotics for
the prevention of infectious complications
including empyema following tube thoracostomy for
trauma: Results of meta-analysis. J Trauma
33: 110
|
III
|
Meta-analysis of six
studies. Only evaluated four studies which used
first or second generation cephalosporins.
Determined impact on early empyema and other
infectious complications. Concluded: Antibiotic
prophylaxis with broad-spectrum first generation
cephalosporin may reduce the potential infectious
complications including empyema that are
associated with tube thoracostomy. |
| Cant PJ |
1993
|
Antibiotic prophylaxis is
indicated for chest stab wounds requiring closed
tube thoracostomy. Brit J Surg
80: 464
|
I
|
Cefazolin
Placebo
|
57
56
|
24 hours
|
12%
34%
|
0%
9%
|
| Evans JT |
1995
|
Meta-analysis of antibiotics
in tube thoracostomy. Am Surg
61: 215
|
III
|
Meta-analysis performed of
same six randomized studies as above. Outcomes
evaluated included: empyema, effusion, pneumonia,
wound infection, tracheitis, Concluded:
Antibiotics should be used and maximize therapy
for Staphlococcus aureus |
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