Facial Soft Tissue Trauma Medication
- Author: Daniel D Sutphin, MD; Chief Editor: Arlen D Meyers, MD, MBA more...
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.
Vaccines, Inactivated, Bacterial
Toxoids are used to induce active immunity.
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.
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.
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 interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
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.
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 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 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 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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