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 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> | ||
* | *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==== | ||
*[[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 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> | ||
*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 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> | ||
====Special Considerations==== | ====Special Considerations==== | ||
*Concern for [[clostridium]] (soil contamination, farm injuries, possible bowel contamination) | *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
- Concern for clostridium (soil contamination, farm injuries, possible bowel contamination): additionally add penicillin[3][2]
- Fresh water wounds: fluoroquinolones OR 3rd/4th generation cephalosporin
- Saltwater wounds (vibrio): doxycycline + ceftazidime OR fluoroquinolone
- ↑ Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.
- ↑ 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
- ↑ 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.