Antibiotic prophylaxis in pre-hospital trauma care: A review of the literature


open wound
penetrating wound
prophylactic antibiotic
emergency medical systems
emergency medical technicians

How to Cite

Smit L, Boyle M. Antibiotic prophylaxis in pre-hospital trauma care: A review of the literature. Australasian Journal of Paramedicine [Internet]. 2014Sep.3 [cited 2021May13];11(5). Available from:




Penetrating and open wounds expose an otherwise sealed and protected body to foreign bodies, leaving the patient vulnerable to potentially fatal infection. The objective of this study was to determine if the administration of systemic prophylactic antibiotics by paramedics for penetrating and/or open wounds leads to decreased infection rates and improved patient outcomes.


A literature search of the electronic medical databases CINAHL, Cochrane, EMBASE and MEDLINE was conducted. The databases were reviewed from January 2000 to March 2013. A pre-hospital search filter was applied to each database with additional search terms of ‘open wound’, ‘penetrating wound’, ‘prophylactic antibiotic’. References of retrieved articles were also reviewed. Articles were included if they reported on the administration of prophylactic antibiotics by paramedics for penetrating or significant open wounds.


A total of 1280 articles were identified in the search with four articles meeting the inclusion criteria. All four articles focused on the combat setting and management of soldiers with combat-related open or penetrating wounds. Two studies supported the use of prophylactic antibiotics whereas the third did not, stating that the evidence was low level and the practice of antibiotic administration was more opinion based.


This study identified that there is scant evidence to support the use of systematic antibiotic prophylaxis in the civilian pre-hospital setting for open wounds. There is a need for further research to identify if this view may change in the future.


Butler F, O'Connor K. Antibiotics in tactical combat casualty care 2002. Mil Med 2003;168:911–4.

Murray CK, Wilkins K, Molter NC, et al. Infections in combat casualties during Operation Iraqi and Enduring Freedom. J Trauma 2009;66(4 Suppl):S138–44.

Cooper ME, Yarbrough DR, Zone-Smith L, Byrne TK, Norcross ED. Application of field triage guidelines by pre-hospital personnel: is mechanism of injury a valid guideline for patient triage? Am Surg 1995;61(4):363–7.

Simon BJ, Legere P, Emhoff T, Fiallo VM, Garb J. Vehicular trauma triage by mechanism: avoidance of the unproductive evaluation. J Trauma 1994;37(4):645–9.

Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev 2004;(1):CD003764.

Rose SC, Moore EE. Trauma angiography of the extremity: the impact of injury mechanism on triage decisions. Cardiovasc Intervent Radiol 1988;11(3):136–9.

Smith E, McDonald S, Wasiak J, Jennings P, MacPherson C, Archer F. The development of a pre-hospital search filter for Cochrane Library. J Emerg Prim Health Care 2004;2:1–2.

Lowe DK, Oh GR, Neely KW, Peterson CG. Evaluation of injury mechanism as a criterion in trauma triage. Am J Surg 1986;152(1):6–10.

Hunt RC. Is mechanism of injury dead? Prehosp Emerg Care 1999;3(1):70–3.

Boyle M, Smith E, Archer F. Trauma incidents attended by emergency medical services in Victoria, Australia. Prehosp Disaster Med 2002;23(1).

Jackson DS. Sepsis in soft tissue limb wounds in soldiers injured during the Falklands Campaign 1982. J R Army Med Corps 1984;130:97–9.

Murray CK, Roop SA, Hospenthal DR, et al. Bacteriology of war wounds at the time of injury. Mil Med 2006;171(9):826–9.

Moran GJ, Talan DA, Abrahamian FM. Antimicrobial prophylaxis for wounds and procedures in the emergency department. Infect Dis Clin North Am 2008;22(1):117–43.

MIMS Online. Full Product Information Cefazolin 2013 [28/01/2014]. Available at: Info&searchKeyword=Cefazolin&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=69080001_2.

Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practise guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195–283.

MIMS Online. Full Product Information Metronidazole 2013 [29/01/2014]. Available at: Info&searchKeyword=Metronidazole&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=79210001_2#an-DosageAdministration7595.

MIMS Online. Full product information Moxifloxacin 2013 [28/01/2014]. Available at: Info&searchKeyword=moxifloxacin&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=55630001_2.

MIMS Online. Full Product Information Cefoxitin 2013 [28/01/2014]. Available at: Info&searchKeyword=Cefoxitin&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=99010001_2#an-DosageAdministration9734.