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Facial Soft Tissue Trauma Medication

  • Author: Daniel D Sutphin, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Aug 17, 2015
 

Medication Summary

Not all facial soft-tissue injuries require pharmacotherapy. When drugs are employed, the goal is to decrease the potential morbidity and mortality and reduce the risk of complications.

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Vaccines, Inactivated, Bacterial

Class Summary

Toxoids are used to induce active immunity.

Tetanus toxoid adsorbed or fluid

 

Tetanus toxoid induces active immunity against tetanus in selected patients. The immunizing agents of choice for most adults and children older than 7 years are the tetanus and diphtheria toxoids. It is necessary to administer booster doses to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen–containing product.

In children and adults, tetanus toxoid may be administered into the deltoid or the midlateral thigh muscles. In infants, the preferred site is the midthigh laterally.

Administer diphtheria and tetanus toxoids 0.5 mL intramuscularly (IM) to patients older than 7 years who have not been immunized within 5 years. Administer tetanus immunoglobulin G (IgG) 250 U at a different site for patients with an incomplete immunization history.

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Immune Globulins

Class Summary

Immunoglobulins are used for passive immunization, consisting of the administration of immunoglobulin that is pooled from the serum of immunized subjects.

Tetanus immune globulin (HyperTET)

 

Tetanus immune globulin (TIG) induces passive immunization in any person with a wound that might be contaminated with tetanus spores.

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Antibiotics

Class Summary

Antibiotics are not recommended as part of routine wound care, particularly with the increasing number of multidrug-resistant bacteria. Empiric treatment is still recommended for wounds that are at high risk of infection. Large intraoral wounds may require treatment with penicillin. Bite injuries from a cat, dog, or human should be covered with amoxicillin-clavulanate or doxycycline and/or cefuroxime.

Because of a change in resistance patterns, cephalexin and dicloxacillin are no longer recommended for empiric treatment in many areas of the country. Methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly problematic in community-acquired infections, and treatment should be based on the community resistance pattern (usually available from local hospitals or infectious disease specialists).

When organism sensitivities are unknown, vancomycin should be considered until culture and sensitivity testing can be performed.

Penicillin G benzathine (Bicillin L-A)

 

Penicillin G interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Penicillin VK

 

Penicillin VK inhibits biosynthesis of cell wall mucopeptide. It is bactericidal against sensitive organisms when adequate concentrations are achieved and is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Amoxicillin and clavulanate (Augmentin, Augmentin XR)

 

The combination of amoxicillin and clavulanate treats bacteria that are resistant to beta-lactam antibiotics. For children older than 3 months, base the dosing protocol on the amoxicillin content. Because of different ratios of amoxicillin to clavulanic acid in the 250-mg tab (250/125) and in the 250-mg chewable tab (250/62.5), do not use the 250-mg tab until the child weighs more than 40 kg.

Doxycycline (Doryx, Adoxa, Ocudox, Vibramycin, Oraxyl)

 

Doxycycline is a broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly the 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Cefuroxime (Ceftin, Zinacef)

 

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of the first-generation cephalosporins and adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis.

Cefuroxime binds to penicillin-binding proteins and inhibits the final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death. The condition of the patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration. Cefuroxime resists degradation by beta-lactamase.

Vancomycin (Vancocin)

 

Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. It is useful in the treatment of septicemia and skin structure infections. It is indicated for patients who are unable to receive penicillins and cephalosporins or whose infections have not responded to these agents, as well as for patients who have infections with resistant staphylococci. Use the creatinine clearance to adjust the dose in patients diagnosed with renal impairment.

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Contributor Information and Disclosures
Author

Daniel D Sutphin, MD Attending Plastic and Reconstructive Surgeon, Mountain View Regional Medical Center

Daniel D Sutphin, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

Armand R Lucas, MD 

Armand R Lucas, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery

Disclosure: Nothing to disclose.

Steve Lee, MD Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC

Steve Lee, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Yelena Bogdan Stony Brook University Health Sciences Center School of Medicine (SUNY)

Yelena Bogdan is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Acknowledgements

Dominique Dorion, MD, MSc, FRCSC, FACS Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Terance (Terry) Ted Tsue, MD Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

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