Template:Antibiotics Open Fracture: Difference between revisions
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===Prophylactic Antibiotics for [[Open fractures]] | ===Prophylactic Antibiotics for [[Open fractures]]=== | ||
''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>'' | ''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>'' | ||
''Duration of antibiotic therapy remains variable between institutions, and antibiotic choice is not standardized''<ref>Garner MR, et al. Antibiotic Prophylaxis in Open Fractures: Evidence, Evolving Issues, and Recommendations. Journal of the American Academy of Orthopaedic Surgeons. April 15, 2020. 28(8):309-315</ref> | |||
====[[Open_fracture|Grade I & II Fractures]] Options==== | ====[[Open_fracture|Grade I & II Fractures]] Options==== | ||
*1st generation [[cephalosporin]]: e.g. [[Cefazolin]] (Ancef) 2g IV TID | *1st generation [[cephalosporin]]: e.g. [[Cefazolin]] (Ancef) 2g IV TID<ref>Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update</ref> | ||
*Allergy to above: [[Clindamycin]] or [[vancomycin]] (25mg/kg) IV | *Allergy to above: [[Clindamycin]] or [[vancomycin]] (25mg/kg) IV | ||
====[[Open_fracture#Grade_III|Grade III Fracture]] Options==== | ====[[Open_fracture#Grade_III|Grade III Fracture]] Options==== | ||
*Treatment as above for Grade I/II | *Treatment as above for Grade I/II | ||
*PLUS [[aminoglycoside]]: e.g. [[Gentamicin]] 300 mg (1-1.7mg/kg) IV | *PLUS [[aminoglycoside]]: e.g. [[Gentamicin]] 300 mg (1-1.7mg/kg) IV<ref>Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update</ref> | ||
**Once daily dosing has been shown to be safe and effective | **Once daily dosing has been shown to be safe and effective | ||
Revision as of 22:39, 12 May 2022
Prophylactic Antibiotics for Open fractures
Initiate as soon as possible; increased infection rate when delayed for >3 hours from injury (NNT 12.5)[1]
Duration of antibiotic therapy remains variable between institutions, and antibiotic choice is not standardized[2]
Grade I & II Fractures Options
- 1st generation cephalosporin: e.g. Cefazolin (Ancef) 2g IV TID[3]
- Allergy to above: Clindamycin or vancomycin (25mg/kg) IV
Grade III Fracture Options
- Treatment as above for Grade I/II
- PLUS aminoglycoside: e.g. Gentamicin 300 mg (1-1.7mg/kg) IV[4]
- Once daily dosing has been shown to be safe and effective
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
- ↑ Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.
- ↑ Garner MR, et al. Antibiotic Prophylaxis in Open Fractures: Evidence, Evolving Issues, and Recommendations. Journal of the American Academy of Orthopaedic Surgeons. April 15, 2020. 28(8):309-315
- ↑ Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update
- ↑ Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update