antibiotics

[donedeal]

Does anyone carry or would there be benefit in carrying IV anti-biotics? I'm thinking in particular for critical burn patients. Is there benefit to providing prophylactic antibiotics IV en route if there will be a prolonged transport to a burn center versus receiving those anti-biotics on arrival at the ED. Will the 20-30 minutes here or there make a difference?

[DartmouthDave]

Does anyone carry or would there be benefit in carrying IV anti-biotics? I'm thinking in particular for critical burn patients. Is there benefit to providing prophylactic antibiotics IV en route if there will be a prolonged transport to a burn center versus receiving those anti-biotics on arrival at the ED. Will the 20-30 minutes here or there make a difference?

Hello,

I have had limited experience with burn patients and only one of these was during the acute phase. He was transfer to a burn center at a large teaching hospital and they didn't want prophylactic abx given.

Second, I think the cost would be an issue. Most of the abx carried would expire before being used since (lucky) critical burns are not that common.

Cheers....

[ERDoc]

There is no indication for prophylactic abx in burn pts. As for prehospital abx for other reasons, I just don't see it as practical. How many different abx are you going to carry?

[1EMT-P]

To be honest with you, I really can't see a reason for most medics to carry antibiotics, unless they are functioning in a disaster, expanded scope of practice or wilderness medicine setting.

[Timmy]

All our ambulances carry ceftriaxone, for what I'm not sure...

[Kiwiology]

We carry ceftriaxone for sepsis and meningococcial septicaemia

[flamingemt2011]

I would have to vote NO. To administer antibiotics correctly, you should do a "culture", then start the patient on a broad-spectrum antibiotic, that they are not allergic too. Once you get the culture back, you would then confirm that the patient is on the right antibiotic, or needs to be changed. I know you specifically referenced a burn patient, but those would be far fewer than your traditional "sick" patients. You also need to know for a fact that it is a bacterial infection and not a viral infection, before you should administer an antibiotic. As mentioned, antibiotics are sometimes expensive, and we really do not have the needed testing capabilities in the field. I will be doing what I think you guys call a "spinoff" topic on this, so stay tuned.

[usalsfyre]

Early, emperic broad spectrum antibiotics are useful in sepsis. Cultures should ideally be drawn before administration (and really, how hard is it to pull cultures if your starting a line) but it's not an absolute.

I don't know about y'all, but I see urosepsis about once a week. In systems with a 5 minute transport, it's probably not worth the trouble. However, if your like my system and transports are from 30 min up to 90 minutes, it's worth considering.

[zippyRN]

We carry ceftriaxone for sepsis and meningococcial septicaemia

the UK paramedic drug list includes Benzylpenicillin for Meningococcal meningitis / septicaemia ...

and to be honest i can't see any particular reason for none extended practitioner paramedics to carry any other ABx. If you are doing out of hours Primary Care / Emergency Care practitioner jobs it's a little different ...

Early, emperic broad spectrum antibiotics are useful in sepsis. Cultures should ideally be drawn before administration (and really, how hard is it to pull cultures if your starting a line) but it's not an absolute.

I don't know about y'all, but I see urosepsis about once a week. In systems with a 5 minute transport, it's probably not worth the trouble. However, if your like my system and transports are from 30 min up to 90 minutes, it's worth considering.

fair and valid points ...

to answer another poster's point about cultures - also while cultures are useful if someone is life threateningly ill with baceterial meningitis or other sepsis beginning Empirical treatment with a broad spectrum Abx is right up there with resuscitation in things to do...

All our ambulances carry ceftriaxone, for what I'm not sure...

as kiwi says probably for meningococal meningitis, it's what we give in hospital that as well

[Bieber]

I think the ability to administer/prescribe antibiotics in a primary care paramedic setting would be appropriate and wise. Ideally, the street paramedic would represent the emergency end of the spectrum and the primary care paramedic would be on the primary care end and handle patients that don't require transport to the hospital.

Have there been any studies done that show a significant change in mortality in septic patients correlating to time of antibiotic administration?