颌面部损伤患者的抗生素使用

Injury	Antibiotic	Pencillin-Allergic	Duration
FACIAL SOFT TISSUE
<12 hr from injury; cleaned, no foreign bodies remain	None	NA	NA
>12 hr, contaminated; foreign bodies remain; delayed closure	Cefazolin, 1 g q8h (add metronidazole, 500 mg IV q6h, to above if grossly contaminated)	Clindamycin, 900 mg IV q8h (add metronidazole, 500 mg IV q6h, to above if grossly contaminated)	48 hr postclosure, change to PO
>12 hr, contaminated, with intraoral communication	Aq Pen G, 2.0 mU IV q4h (add metronidazole to above if grossly contaminated)	Clindamycin, 900 mg IV q8h (add metronidazole to above if grossly contaminated)	48 hr postclosure, change to PO
MANDIBULAR FRACTURES
Condyle, closed	None	NA	NA
Open fracture (intraoral wound)	Aq Pen G, 2.0 mU IV q4h	Clindamycin, 900 mg IV q8h	IV until fracture trx, then 48 hr postop
Open fracture + gross contamination ± delayed trx	Ampicillin-sulbactam, 1.5 gr IV q6h	Clindamycin, 900 mg IV q8h plus Metronidazole, 500 mg IV q6h	72 hr post-treatment
ZYGOMATIC, MAXILLARY FRACTURE	None	NA	NA
FRONTAL SINUS FRACTURE	Ampicillin-sulbactam, 1.5 g IV q6H	Clindamycin, 900 mg IV q8h	72 hr postoperatively
PANFACIAL FRACTURE (CONTAMINATED)	Ampicillin-sulbactam, 1.5 g IV q6h or Piperacillin-tazobactam, 3.375 g IV q6h	Clindamycin, 900 mg IV q8h plus Levofloxacin, 750 mg IV or PO qd	72 hr postoperatively

1. NA, Not applicable.
2. Adapted from U.S. Army Institute of Surgical Research: Joint theater traumasystem clinical practice guideline: Guidelines to prevent infection in combat-related injuries, 2012 (http://www.usaisr.amedd.army.mil/assets/cpgs/Infection_Control_2_Apr_12.pdf).

备注：表格摘自RAYMOND J. FONSECA等主编的Oral and Maxillofacial Trauma, 4th edition (Page 802)