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<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====
*[[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 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>
*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>
*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>


====[[Open_fracture#Grade_III|Grade III Fracture]] Options====
====[[Open_fracture#Grade_III|Grade III Fracture]] Options====
*Treatment as above for Grade I/II
*[[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>
*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>
*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>
**Once daily dosing has been shown to be safe and effective


====Special Considerations====
====Special Considerations====
*Concern for [[Clostridium]] (soil contamination, farm injuries, possible bowel contamination): single drug regimen of [[Pipericillin/Tazobactam]] 4.5g (80mg/kg) IV TID
*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]]
*Fresh water wounds: [[fluoroquinolones]] OR 3rd/4th generation [[cephalosporin]]
*Saltwater wounds: [[doxycycline]] + [[ceftazidime]] OR [[fluoroquinolone]]
*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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