Related Experiment Video
Updated: Dec 28, 2025
Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings
Published on: December 4, 2021
Pediatric Prehospital Wound Prophylaxis in Iraq and Afghanistan
Jason F Naylor1, Michael D April2, Guyon J Hill3
1Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Tacoma, WA 98431.
Insights
Antibiotic use in pediatric war casualties was infrequent, with cephalosporins being most common. Pediatric-specific guidelines and training are needed to improve prehospital wound prophylaxis for children injured in combat.
Area of Science:
- Military medicine
- Pediatric trauma
- Infectious disease
Background:
- Infectious complications of combat wounds pose significant risks.
- Tactical Combat Casualty Care (TCCC) guidelines suggest specific antibiotics for open combat wounds.
- This study examines prehospital antibiotic administration in pediatric trauma patients.
Purpose of the Study:
- To describe the patterns of prehospital antibiotic administration in pediatric trauma patients.
- To evaluate the adherence to existing guidelines in pediatric combat casualties.
- To identify potential improvements for pediatric prehospital wound prophylaxis.
Main Methods:
- Data from the Department of Defense Trauma Registry were analyzed.
- Pediatric subjects admitted to fixed-facility hospitals in Iraq and Afghanistan (2007-2016) were included.
- Antibiotic administration records were reviewed for 3,439 pediatric encounters.
Main Results:
- 216 antibiotic doses were given to 210 pediatric subjects.
- Cephalosporins (cefazolin, ceftriaxone) were the most frequently administered antibiotics.
- Older male children in Afghanistan injured by explosives received antibiotics more often.
Conclusions:
- Current TCCC guidelines for adult wound prophylaxis were infrequently applied to pediatric casualties.
- Pediatric-specific TCCC guidelines recommending cephalosporins could improve prophylaxis.
- Enhanced training and pediatric-specific Broselow tapes may increase appropriate antimicrobial administration.
Background:
Infectious complications of war wounds are a significant source of mortality and morbidity. Tactical Combat Casualty Care (TCCC) guidelines recommend prehospital moxifloxacin, ertapenem, or cefotetan for "all open combat wounds." We describe the prehospital administration of antibiotics to pediatric trauma patients.
Methods:
We queried the Department of Defense Trauma Registry for all pediatric subjects admitted to United States and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016.
Results:
During this time, there were 3,439 pediatric encounters which represented 8.0% of all admissions. Prehospital providers administered a total of 216 antibiotic doses to 210 subjects. Older children received antibiotics more frequently than younger children, were more likely to be male, located in Afghanistan, and injured by explosive with the majority surviving to hospital discharge. Cefazolin and ceftriaxone were the most frequently utilized antibiotics.
Conclusions:
The most frequently administered antibiotics were cephalosporins. TCCC recommended agents for adult prehospital wound prophylaxis were infrequently administered to pediatric casualties. Administration rates of pediatric prehospital wound prophylaxis may be improved with pediatric-specific TCCC guidelines recommending cephalosporins as first-line agents, fielding of a TCCC-oriented Broselow tape, and training prehospital providers on administration of antimicrobials.
Related Concept Videos
01:23Hand hygiene
Hand washing...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:29Drug Dosing: Infants and Children
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...