• Whitney J Barrett, Kevin A Kaucher, Ross E Orpet, Christopher B, Colwell0000-0003-1375-7056Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA National Association of EMS Physicians., and John W Lyng.
• Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
• Prehosp Emerg Care. 2025 Jan 31: 1131-13.

ObjectivesTo conduct a literature review and provide a summary of the evidence surrounding prehospital administration of antibiotics for open fractures and other major open wounds.MethodsWe performed a literature search and summarized the evidence following the methodology established for the NAEMSP Prehospital Trauma Compendium. We searched PubMed from inception to 23 December 2022 for articles relevant to Emergency Medical Services, trauma, and antibiotics. Due to resource limitations, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was not used during review of the evidence, and no formal assessment of bias or strength of evidence was performed.ResultsOf 105 articles identified in the initial search, 13 articles were included in the final evidence review and synthesis. Prehospital administration of antibiotics in combat and civilian trauma patients consists of mostly observational, retrospective studies that describe use as likely safe, but with uncertainty as to its effect on important clinical outcomes. Both combat and civilian analyses of protocol adherence and inter-rater reliability for recognition and treatment of injuries have also produced variable and inconsistent results. These results pose a challenge for implementation and highlight the inherent limitations and external validity of efficacy outcomes published to date.ConclusionsPrehospital administration of prophylactic antibiotics for trauma appears safe and may be considered in some specific patient populations. Universal and widespread adoption of this intervention needs further study to identify the true impact on patient-centered outcomes and identification of patients who might confer greatest benefit. Local practice characteristics may support adoption of multidisciplinary-developed prudent and practicable protocols incorporating the use of prophylactic antibiotics for some trauma patients such as those with open fractures or those with significant delays in transport to definitive care. Future research should attempt to address the appropriate identification of wounds and injury patterns that have the highest likelihood of benefit from prehospital administration of antibiotics, the ideal timing of administering the antibiotic(s) following initial injury, impact on infection rates, and other important patient outcomes.

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