Use of Antibiotics in Pediatric Patients with Penetrating Brain/CNS Injury

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Original Date: 04/2017, 09/2021 | Last Review Date: 02/21/2024 (Reviewed with no changes)
Purpose: To provide antibiotic coverage recommendations of pediatric patients with penetrating Brain/CNS injuries.

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Procedure

For penetrating ballistic wounds to the CNS:

Nafcillin and ceftriaxone (gram+/- coverage) IV for 72 hours

If gross contamination is found at the time of decompression and/or debridement OR for very low-energy penetrating wounds (i.e. knives, arrows) as well as wounds which involve the maxillofacial structures:

Nafcillin, ceftriaxone, and metronidazole (broader anaerobic coverage) IV for 72 hours

* Vancomycin can be used in patients who have an allergy to PCN and ciprofloxacin can be used for patients who have an allergy to cephalosporin.

References

Hospenthal DR, Holcomb JB, et al. Guidelines for the Prevention of Infection After Combat-Related Injuries. J Trauma. 2008;64:S211–S220.

Jimenez, CM, Polo J, Espana JA. Risk Factors for Intracranial Infection Secondary to Penetrating Craniocerebral Gunshot Wounds in Civilian Practice. World Neurosurg. (2013) 79, 5/6:749-755.