Give antibiotics if penetrating injury, open skull fracture or pre-operative.

Administer until closure of skull fracture as per neurosurgical management

Antibiotic recommendation

Recommended antibiotic

Ceftriaxone 2g IV 12 hourly

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

If MRSA positive

ADD

Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L
Severe penicillin allergy

Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

PLUS

Ciprofloxacin 400mg IV 8 hourly *

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

*Avoid fluoroquinolones if taking steroids and the elderly. Review MHRA Quinolone Warning before prescribing. If an alternative agent is required please contact microbiology.

Notes

  • Common organisms include: staph aureus, streptococci,  anaerobes, enterobacteriaceae.