Medication Summary

Infection subsequent to penetrating wounds of the neck is a major cause of death and disability. Administering prophylactic antibiotics, while not decisively validated by scientific studies, should be a consideration. Recommended medications vary from penicillin to those with broad-spectrum coverage. Factors to consider include the physical nature of the injury (eg, simple laceration vs blunt trauma with tearing-type injuries). If prophylactic antibiotics are to be effective, attempt to obtain adequate tissue levels immediately, preferably within 4 hours of injury.

Other therapeutic agents to consider are the corticosteroids. Massive doses of steroids are believed to have possible benefit in improving neurologic function in selected subsets of patients. In the second phase of a benchmark study, patients who had sustained blunt spinal injury within a 12-hour time frame were given a 30 mg/kg intravenous (IV) bolus of corticosteroids followed by 5.4 mg/kg/hr for 23 hours. Overall, patients who appropriately received steroids within 8 hours revealed slight improvement in motor and sensory function at 6 months. Other experimental agents include naloxone, dimethylsulfoxide, and growth factors. Spinal cooling also has been proposed.

Drugs that facilitate endotracheal intubation, especially those used for rapid sequence intubation, should be readily available.

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Cefotetan (Cefotan)

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Second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods.

Dosage and route of administration depends on condition of patient, severity of infection, and susceptibility of causative organism.

Gentamicin (Garamycin)

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Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Not the DOC. Consider if penicillins or other less toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms.

Ampicillin (Omnipen)

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Bactericidal activity against susceptible organisms. Alternative to amoxicillin when patient unable to take medication orally.

Clindamycin (Cleocin)

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Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-tRNA from ribosomes causing RNA-dependent protein synthesis to arrest.

Ceftriaxone (Rocephin)

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Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

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Media Gallery

Neck trauma. Zones of the neck.
Neck trauma. Zone I injury.
Neck trauma. Zone II injury.
Neck trauma. Zone III injury.

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Author

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Brian S Gruber, MD Clinical Assistant Professor of Surgery, Northeastern Ohio Universities College of Medicine; Clinical Assistant Professor of General/Trauma Surgery, Ohio University College of Osteopathic Medicine; Director, Department of Trauma and Critical Care Services, St Elizabeth Health Center

Brian S Gruber, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Ohio State Medical Association, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, Society of Laparoscopic and Robotic Surgeons, Eastern Association for the Surgery of Trauma

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Edmond A Hooker, II, MD, DrPH, FAAEM Associate Professor, Department of Health Services Administration, Xavier University, Cincinnati, Ohio; Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker, II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, Southern Medical Association

Disclosure: Nothing to disclose.

Neck Trauma Management Medication

Medication Summary

Antibiotics