Open Fractures, Prophylactic Antibiotic Use in — Update
Published 2011
Level 1
Systemic antibiotic coverage directed at gram-positive organisms should be initiated as soon as possible after injury.
Additional gram-negative coverage should be added for type III fractures.
High-dose penicillin should be added in the presence of fecal or potential clostridial contamination (e.g., farm-related injuries).
Fluoroquinolones offer no advantage compared with cephalosporin/aminoglycoside regimens. Moreover, these agents may have a detrimental effect on fracture healing and may result in higher infection rates in type III open fractures.
In type III fractures, antibiotics should be continued for 72 hours after injury or not >24 hours after soft tissue coverage has been achieved.
Once-daily aminoglycoside dosing is safe and effective for types II and III fractures.
Level 2
In type III fractures, antibiotics should be continued for 72 hours after injury or not >24 hours after soft tissue coverage has been achieved.
Once-daily aminoglycoside dosing is safe and effective for types II and III fractures.
