野外與登山醫學-何時使用口服抗生素預防傷口感染-(from WMS 2014年.基本傷口處置原則)

2023-10-25 11:22AM
另一篇筆記: 野外與登山醫學----預防及避免傷口感染
(這篇引用的是WMS 2014 年指引.Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment)

2023-10-23 先寫目前做法. 實證醫學慢慢查
建議帶第一代頭孢素, 例如  Cephalexin, 這也是急診最常使用到的預防性抗生素

腎功能正常的人, 通常每六小時吃一顆 500mg. 連續吃三天. 

另外. 什麼型態的傷口應該吃, 

有一篇 2012年的研究報告可參考
Current Concepts of Prophylactic Antibiotics in Trauma: A Review
另外找時間整理. 

2023-10-17 18:36
這篇2014年發表於WMS 荒野醫學期刊-嚴峻環境的外傷基本臨床處置指引
Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment

IMMUNIZATION

Tetanus

Tetanus is the only vaccine-preventable disease that is infectious but not contagious. The need for active

immunization, with or without passive immunization, depends on the condition of the wound and the patient’s immunization history. Tetanus immunization status should be evaluated for all patients with a traumatic wound and treated appropriately based on the patient’s history and risk of infection.21–23 Table 2 shows current recommendations for tetanus. Development of clinical tetanus can probably be delayed with oral antibiotics (penicillin and likely others) and should be used if evacuation of an unimmunized patient with a tetanusprone wound will be delayed or is logistically complicated. This technique is often used in patients claiming an allergy to tetanus toxoid. 

Recommendation

Tetanus immunization, if indicated based on a patient’s history and exposure, should be given to all patients with a traumatic wound. Recommendation grade: 1C.

關於使用口服抗生素預防傷口感染, 指引是引用兩篇研究報告. 

130. Cummings P, Del Beccarro MA. Antibiotics to prevent infection of simple wounds: a meta-analysis of randomized studies. Am J Emerg Med. 1995;13:396–340.  

21. Chapman LE, Sullivent EE, Grohskopf LA, et al.

Centers for Disease Control and Prevention (CDC).

Recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings and other mass-casualty events—United States, 2008: recommendations of the Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2008;57:1–21.