Template:Antibiotics Open Fracture: Difference between revisions
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====[[Open_fracture|Grade I & II Fractures]] Options==== | ====[[Open_fracture|Grade I & II Fractures]] Options==== | ||
*[[Cefazolin]] (Ancef) 2 g IV immediately and q8 hours x 3 total doses<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> | *[[Cefazolin]] (Ancef) 2 g IV (immediately and q8 hours x 3 total doses)<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> | ||
*Allergy to above: [[clindamycin]] 900 mg IV immediately and q8 hours x 3 total doses<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> | *Allergy to above: [[clindamycin]] 900 mg IV (immediately and q8 hours x 3 total doses)<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_III|Grade III Fracture]] Options==== | ====[[Open_fracture#Grade_III|Grade III Fracture]] Options==== | ||
*[[Ceftriaxone]] 2 g IV immediately x 1 total dose PLUS [[vancomycin]] 1 g IV immediately and q12 hours x 2 total doses<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> | *[[Ceftriaxone]] 2 g IV (immediately x 1 total dose) PLUS [[vancomycin]] 1 g IV (immediately and q12 hours x 2 total doses)<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> | ||
*Cephalosporin allergy: [[aztreonam]] 2 g IV immediately and q8 hours x 3 PLUS [[vancomycin] 1 g IV immediately and q12 hours x 2 total doses<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> | *Cephalosporin allergy: [[aztreonam]] 2 g IV (immediately and q8 hours x 3) PLUS [[vancomycin] 1 g IV (immediately and q12 hours x 2 total doses)<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> | ||
====Special Considerations==== | ====Special Considerations==== | ||
Revision as of 09:48, 14 May 2022
Prophylactic Antibiotics for Open fractures
Initiate as soon as possible; increased infection rate when delayed[1]
Grade I & II Fractures Options
- Cefazolin (Ancef) 2 g IV (immediately and q8 hours x 3 total doses)[2]
- Allergy to above: clindamycin 900 mg IV (immediately and q8 hours x 3 total doses)[3]
Grade III Fracture Options
- Ceftriaxone 2 g IV (immediately x 1 total dose) PLUS vancomycin 1 g IV (immediately and q12 hours x 2 total doses)[4]
- Cephalosporin allergy: aztreonam 2 g IV (immediately and q8 hours x 3) PLUS [[vancomycin] 1 g IV (immediately and q12 hours x 2 total doses)[5]
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
- ↑ 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
- ↑ 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
- ↑ 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