Antimicrobial Prophylaxis in Patients with Major Trauma

Purpose of Review: Prophylactic antibiotics are used to reduce infection after major trauma, but their use remains controversial. The purpose of this review is to revisit evidence-based practical guidelines in the use of prophylactic antibiotics in major trauma. Recent Findings: For head trauma, prophylactic antibiotics can reduce ventilator-associated pneumonia and are indicated for penetrating injury. For thoracic trauma, antibiotic use can reduce empyema after chest tube insertion in penetrating chest trauma but not indicated for blunt chest trauma. In abdominal trauma, prophylactic antibiotics are suggested for 24 h after laparotomy if hollow viscus injured. Regarding to open fracture, an antibiotic to cover gram-positive organisms should be administrated as soon as possible after injury and gram-negative coverage is added for type III fractures. Summary: The use of prophylactic antibiotics in major trauma should take local factors and guideline suggestions together into consideration. Liberal use is not recommended and individualized consideration is crucial.