Template:Antibiotics Open Fracture: Difference between revisions

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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.

[1] Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.

[Garner2020-2] 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.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
-*NNT 16 to prevent early fracture site infection<ref>TheNNT.com Early Antibiotic Use in Open Fractures http://www.thennt.com/nnt/antibiotics-for-open-fractures/</ref>
+<noinclude><languages/></noinclude>
-====Grade I Fracture Options====
+<translate>
-*[[Cefazolin]] (Ancef) 2g IV three times daily
-*[[Ciprofloxacin]] 400mg IV BID (avoid in pediatrics)
-====Grade II/III Fracture Options====
+===Prophylactic Antibiotics for [[Special:MyLanguage/Open fractures|Open fractures]]=== <!--T:1-->
-*Add [[Gentamicin]] 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
-*If concern for [[Clostridium]] then consider single drug regimen of [[Pipericillin/Tazobactam]] 4.5g (80mg/kg) IV three times daily
+<!--T:2-->
+''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>''
+====[[Special:MyLanguage/Open_fracture|Grade I & II Fractures]] Options==== <!--T:3-->
+<!--T:4-->
+*[[Special:MyLanguage/Cefazolin|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: [[Special:MyLanguage/clindamycin|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>
+====[[Special:MyLanguage/Open_fracture#Grade_III|Grade III Fracture]] Options==== <!--T:5-->
+<!--T:6-->
+*[[Special:MyLanguage/Ceftriaxone|Ceftriaxone]] 2 g IV (immediately x 1 total dose) PLUS [[Special:MyLanguage/vancomycin|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: [[Special:MyLanguage/aztreonam|aztreonam]] 2 g IV (immediately and q8 hours x 3) PLUS [[Special:MyLanguage/vancomycin|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==== <!--T:7-->
+<!--T:8-->
+*Concern for [[Special:MyLanguage/clostridium|clostridium]] (soil contamination, farm injuries, possible bowel contamination): additionally add [[Special:MyLanguage/penicillin|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: [[Special:MyLanguage/fluoroquinolones|fluoroquinolones]] OR 3rd/4th generation [[Special:MyLanguage/cephalosporin|cephalosporin]]
+*Saltwater wounds ([[Special:MyLanguage/vibrio|vibrio]]): [[Special:MyLanguage/doxycycline|doxycycline]] + [[Special:MyLanguage/ceftazidime|ceftazidime]] OR [[Special:MyLanguage/fluoroquinolone|fluoroquinolone]]
+</translate>