Template:Antibiotics Open Fracture: Difference between revisions
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===Prophylactic Antibiotics for [[Open fractures]]<ref>Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update</ref>===
===Prophylactic Antibiotics for [[Open fractures]]<ref>Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update</ref>===
''NNT 12.5 to prevent early fracture site infection<ref>Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.</ref>''
''Initiate as soon as possible; increased infection rate when delayed for >3 hours from injury (NNT 12.5)<ref>Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.</ref>''


====Grade I & II Fractures Options====
====Grade I & II Fractures Options====
*[[Cefazolin]] (Ancef) 2g IV TID
*1st generation [[cephalosporin]]: e.g. [[Cefazolin]] (Ancef) 2g IV TID
*[[Ciprofloxacin]] 400mg IV BID (avoid in pediatrics)
*Allergy to above: [[Clindamycin]] or [[vancomycin]]  


====Grade III Fracture Options====
====Grade III Fracture Options====
*Add [[Gentamicin]] 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
*Treatment as above for Grade I/II
*PLUS [[aminoglycoside]]: e.g. [[Gentamicin]] 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
**Once daily dosing has been shown to be safe and effective
**Once daily dosing has been shown to be safe and effective
*If concern for [[Clostridium]] (soil contamination, farm injuries) then consider single drug regimen of [[Pipericillin/Tazobactam]] 4.5g (80mg/kg) IV TID
 
====Special Considerations====
*Concern for [[Clostridium]] (soil contamination, farm injuries, possible bowel contamination): single drug regimen of [[Pipericillin/Tazobactam]] 4.5g (80mg/kg) IV TID
*Fresh water wounds: [[fluoroquinolones]] OR 3rd/4th generation [[cephalosporin]]
*Saltwater wounds: [[doxycycline]] + [[ceftazidime]] OR [[fluoroquinolone]]

Revision as of 05:10, 18 September 2018

Prophylactic Antibiotics for Open fractures[1]

Initiate as soon as possible; increased infection rate when delayed for >3 hours from injury (NNT 12.5)[2]

Grade I & II Fractures Options

Grade III Fracture Options

  • Treatment as above for Grade I/II
  • PLUS aminoglycoside: e.g. Gentamicin 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
    • Once daily dosing has been shown to be safe and effective

Special Considerations

  1. ↑ Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update
  2. ↑ Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.
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