Template:Antibiotics Open Fracture: Difference between revisions

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===Prophylactic Antibiotics for [[Open fractures]]===
===Prophylactic Antibiotics for [[Open fractures]]===
''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<ref>Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.</ref>''


====Grade I Fracture Options====
====[[Open_fracture|Grade I & II Fractures]] Options====
*[[Cefazolin]] (Ancef) 2g IV TID
*[[Cefazolin]] (Ancef) 2 g IV (immediately and q8 hours x 3 total doses)<ref name=Garner2020>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>
*[[Ciprofloxacin]] 400mg IV BID (avoid in pediatrics)
*Cephalosporin allergy: [[clindamycin]] 900 mg IV (immediately and q8 hours x 3 total doses)<ref name=Garner2020>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>


====Grade II/III Fracture Options====
====[[Open_fracture#Grade_III|Grade III Fracture]] Options====
*Add [[Gentamicin]] 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
*[[Ceftriaxone]] 2 g IV (immediately x 1 total dose) PLUS [[vancomycin]] 1 g IV (immediately and q12 hours x 2 total doses)<ref name=Garner2020>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>
**Once daily dosing has been shown to be safe and effective
*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 name=Garner2020>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>
*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): additionally add [[penicillin]]<ref>HoffWS, Bonadies JA, Cachecho R, Dorlac WC: East practice management guidelines work group: Update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma 2011;70:751-754.</ref><ref name=Garner2020>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>
*Fresh water wounds: [[fluoroquinolones]] OR 3rd/4th generation [[cephalosporin]]
*Saltwater wounds ([[vibrio]]): [[doxycycline]] + [[ceftazidime]] OR [[fluoroquinolone]]

Latest revision as of 09:58, 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]
  • Cephalosporin allergy: clindamycin 900 mg IV (immediately and q8 hours x 3 total doses)[2]

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)[2]
  • 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)[2]

Special Considerations

  1. ↑ Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 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
  3. ↑ HoffWS, Bonadies JA, Cachecho R, Dorlac WC: East practice management guidelines work group: Update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma 2011;70:751-754.
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