[Antibiotic treatment for traumatic brain injury patients without positive bacterial cultures].

Prophylactic administration of antibiotics is prevalent for traumatic patients including head injury, when the patients have contaminated wounds, CSF leakage, and multiple injuries. In cases with prolonged fever and inflammatory signs, other antibiotics must be selected without confirming the infections by cultures. Usually, 1st or 2nd generation cefalosporins are selected as empiric therapy for traumatic patients, but, successive antibiotics are usually selected according to the situation. In this study, we analyzed 60 cases of head injured patients with Glasgow Coma Scale under 12, in terms of the selection of antibiotics and the reasons for the antibiotic selections. CEZ > PIPC > FMOX were used for initial treatment without any culture results. The second selection was made without any positive culture results in 85.7%, and tertiary selection without culture results in 50% of the patients. CPR > CFSL > FMOX > PAPM/BP were mainly used as second selection, and IPM/CS > CPR = PIPC were mainly used as tertiary selection. In cases with traumatic brain injuries, it is important to prevent antibiotic resistances. 1) by selecting appropriate antibiotics, 2) by using antibiotics after excluding catheter related infections, 3) by not using antibiotics and performing frequent cultures when no apparent infection focuses are detected.