Antibiotics in Tactical Combat Casualty Care 2025: TCCC Change 25-1

Tactical Combat Casualty Care (TCCC) guidelines have his-torically recommended antibiotics for combat wounds due to potential delays in evacuation and wound contamination. The currently recommended agents, moxifloxacin (oral) and ertap-enem (parenteral), have not been recently reviewed. This paper documents the findings of a multidisciplinary panel convened in 2023 to re-evaluate TCCC antibiotic recommendations con-sidering current antibiotic options, emerging data regarding multi-drug resistance (MDR), and evolving combat wound microbiology. The panel addressed four key questions through literature review and expert discussion: the optimal timing for antibiotic administration, whether recommendations change for invasive procedures, the inclusion of topical antibiotics, and the need to update antibiotic choices. The review reaffirmed the importance of early antibiotic administration, recommended antibiotic prophylaxis for any invasive procedure in the TCCC setting, found insufficient evidence to recommend topical an-tibiotics at this time, and proposed updates to the antibiotic choices based on factors like spectrum, side effects, stability, dosing, and cost. The panel recommends changing the oral antibiotic to cefadroxil (preferred) or cephalexin (alternative) and the parenteral antibiotic to ceftriaxone. In light of these changes in TCCC antibiotics, considerations should be made within Prolonged Casualty Care guidelines for the narrower spectrum of antibiotics and surveillance for unanticipated in-creases in specific injury patterns such as post-traumatic en-dophthalmitis, open fractures, or abdominal injuries.