Wound Therapy

Wound Therapy


Antibiotic Therapy for Traumatic Wounds



Basic Information image



Procedure




• Antibiotics used in wound lavage/irrigation.


image Addition of antibiotics to the lavage solution markedly reduces the number of bacteria in a wound.

image 1% neomycin solution is effective in preventing infection in wounds experimentally contaminated with feces.

image In a double-blind study done on 260 sutured lacerations, penicillin sprayed on the wound before closure reduced infection by 75%.

• Antibiotics systemic: General comments


image Decision is easy: Selection depends on type and location of wound.

image Systemic: (±broad spectrum)

image Pulse dosing improves antibiotic penetration.

image Parenteral recommended initially. IV is preferred because its effects are predictable. IM absorption is often prolonged and variable and depends on the site selection and amount of exercise.

image Oral is used after adequate blood levels have been achieved.

• Antimicrobial choices


image Superficial wounds: Generally not needed in clean wounds <3 hours duration that are sutured or left to heal by second intention. Generally needed for heavily contaminated wounds >3 hours duration. Antibiotics used include penicillin (22,000–44,000 IU/kg IV q6 or IM q12h) alone or in combination with TMS (15 mg/kg PO q12h).

image Deeper wounds involving synovial cavities: Penicillin, ampicillin (6.6–11 mg/kg IM or IV q8–12h), or cefazolin (11 mg/kg IV or IM q6–8h) in combination with an aminoglycoside

image Gentamicin (6.6 mg/kg IV or IM q24h) or amikacin (15–25 mg/kg IV or IM q24h). Combination is synergistic.

image Ceftiofur (adult = 2.2–4.4 mg/kg IM or IV q12h; foals 4–6 mg/kg IV or IM q12h) or enrofloxacin (5 mg/kg IV q12–24h or 7.5 mg/kg PO q24h [not recommended for foals]) reserved for bacteria resistant to all previously mentioned antibiotics.

image Deep fascial cellulitis/septic myositis due to Clostridia

image High doses of penicillin, ampicillin, or cephazolin and metronidazole (15 mg/kg PO q6–8h) or rifampin (5–10 mg/kg PO q12–24h) or ceftiofur.

image Pyonecrotic processes

image Metronidazole and penicillin

• Duration of antimicrobial therapy


image Minimum course: 3 to 5 days

image Established soft tissue infection: 7 to 10 days

image Established synovial infection: 10 to 21 days

image Established bone infection: 3 to 6 months

image NOTE: Wounds contaminated with 109 microorganisms/g of tissue will develop infection despite antibiotic treatment.

• Topical antibiotics (TAs)


image Can retard wound healing, especially some ointments or creams (eg, nitrofurazone [Furacin] and Gentamicin cream).

image Solutions most effective when applied to wounds before closure or as lavage/irrigation solutions.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Wound Therapy

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