Transcript ANTIBIOTICS IN TACTICAL COMBAT CASUALTY CARE (TCCC)

ANTIBIOTICS IN TACTICAL
COMBAT CASUALTY CARE
(TCCC)
Infections and sepsis are a late
cause of morbidity and mortality in
combat trauma patients.
Recommendations for and
commentary on early administration
of antibiotics in the combat casualty
have been recorded since WWII.
ANTIBIOTICS IN TCCC
All wounds sustained on the
battlefield should receive antibiotics.
But at a minimum, any patient
presenting with penetrating
abdominal trauma, massive soft
tissue damage, a grossly
contaminated wound, open fracture,
or a long delay in CASEVAC/MEDVAC
should receive prophylactic
antibiotics.
ANTIBIOTICS IN TCCC

War wound antibiotics need to be simple,
practical, effective, have a good safety
profile, and a broad spectrum of activity.
 Treatment should start immediately and
continue at least until surgical
debridement has occurred.
 Coverage should be appropriate for the
organisms implicated in combat wound
infections.
ANTIBIOTICS IN TCCC

Consideration should be made as to
how far forward the BN PA/MD want
to push antibiotic supplies and
release authority. This will depend
on several factors:
Supply/Re-supply
Education and training level of Medics,
Combat Life Savers, and Laymen
Mission and Unit priority
PILL AND PARENTAL
PACKS

Pill Packs may be available thru the hospital
Pharmacy/MedLog, or if stocks are plentiful
can be assembled and packaged at the BAS.
 Parental Packs could also be assembled and
used by the medics as directed; particularly
if their CASEVAC may by-pass the BAS enroute to the FST.
 PAs/MDs must educate and emphasize
judicious use particularly of p.o. antibiotics
to decrease development of resistant
organisms.
ORAL PROPHYLAXIS

Decrease the logistical burden of
carrying, reconstitution and injection of
parental medications
 Simple, light, durable, and easily
administered
 Single agent DOC is #1Gatifloxacin
followed by #2Moxifloxacin
 More realistic choices would be
Levofloxacin or Ciprofloxacin alone or in
combination with Metronidazole or
Clindamycin
PARENTAL ANTIBIOTICS

Should be used in unconscious casualties, patients
in shock, and penetrating abdominal trauma
 Does not lessen the importance of rapid transit to
definitive care and surgical treatment
 Successful regimes include:
– Single Agents #1Cefoxitin 1-2 Gms TID IV/IM. If IV
push over 3-5 minutes. #2. Ertapenum 1Gm qd
IV/IM. If IV, it must be given over 30 minutes. If
IM, it should be mixed with 3.2cc of 1% Lidocaine
without Epinephrine.
– Combinations: #1Gentamicin and Clindamycin,
#2Tobramycin and Clindamycin.
– What you’ll probably have and use most will be
Cefazolin and Ciprofloxacin.
MES SICKCALL

P.O. Antibiotics
– Pen VK
– Clindamycin
– Cephalexin
– Doxycycline
– Augmentin
– Metronidazole
– Ciprofloxacin
– Azithromycin
– Gatifloxacin
– Sulfamethoxazole

Parental
Antibiotics
– Ceftriaxone
– Cefazolin
MES TRAUMA

P.O. Antibiotics
– Gatifloxacin

Parental
Antibiotics
– Cefazolin
– Ciprofloxacin
AS SOON AS YOU ARRIVE



Perform an inventory.
Differentiate NEED and “nice to have”
Be prepared to barter, do favors, and kissup to get what you want
PRIOR TO MISSION

Request and or prepare Pill Packs and
Parental Packs for the BAS, Platoon
Medics, Combat Life Savers, and Laymen
as supplies, training, mission, and
confidence dictate.
 Pre-think drug protocols and
combinations.
 Don’t break the bank on “Pet Drugs”.
DURING MISSION
BE AGGRESSIVE.
 Don’t be afraid to go “Old School”.
 Safeguard your “Z-Packs”.
 Resist using Cipro for every soft
stool.
 Use good wound care and frequent
re-eval to optimize AB effect.
 Anticipate shortages, and order
early!!!
