Template:Antibiotics Open Fracture: Difference between revisions
(Add pediatric dosing for open fracture prophylaxis)
 
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===Prophylactic Antibiotics for [[Open fractures]]<ref>Open Fractures, Prophylactic Antibiotic Use in — Update. https://www.east.org/education/practice-management-guidelines/open-fractures-prophylactic-antibiotic-use-in-update</ref>===
===Prophylactic Antibiotics for [[Open fractures|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>''


====Grade I & II Fractures Options====
''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>''
*[[Cefazolin]] (Ancef) 2g IV TID
*[[Ciprofloxacin]] 400mg IV BID (avoid in pediatrics)


====Grade III Fracture Options====
====[[Open_fracture|Grade I & II Fractures]] Options====
*Add [[Gentamicin]] 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
 
**Once daily dosing has been shown to be safe and effective
*{{AntibioticDose|disease=Open fracture|drug=Cefazolin|dose=2 g IV (immediately and q8 hours x 3 total doses)|context=Grade I & II Fractures}} (Ancef)<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
*Cephalosporin allergy: {{AntibioticDose|disease=Open fracture|drug=Clindamycin|dose=900 mg IV (immediately and q8 hours x 3 total doses)|context=Grade I & II, Cephalosporin allergy}}<ref name=Garner2020/>
 
====[[Open_fracture#Grade_III|Grade III Fracture]] Options====
 
*{{AntibioticDose|disease=Open fracture|drug=Ceftriaxone|dose=2 g IV (immediately x 1 total dose)|context=Grade III Fractures}} PLUS {{AntibioticDose|disease=Open fracture|drug=Vancomycin|dose=1 g IV (immediately and q12 hours x 2 total doses)|context=Grade III Fractures}}<ref name=Garner2020/>
*Cephalosporin allergy: {{AntibioticDose|disease=Open fracture|drug=Aztreonam|dose=2 g IV (immediately and q8 hours x 3)|context=Grade III, Cephalosporin allergy}} PLUS [[Vancomycin]] 1 g IV (immediately and q12 hours x 2 total doses)<ref name=Garner2020/>
 
====Special Considerations====
 
*Concern for [[clostridium|clostridium]] (soil contamination, farm injuries, possible bowel contamination): additionally add [[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/>
*Fresh water wounds: [[fluoroquinolones|fluoroquinolones]] OR 3rd/4th generation [[cephalosporin|cephalosporin]]
*Saltwater wounds ([[vibrio|vibrio]]): [[doxycycline|doxycycline]] + [[ceftazidime|ceftazidime]] OR [[fluoroquinolone|fluoroquinolone]]
 
====Pediatric====
=====Grade I & II=====
*{{AntibioticDose|disease=Open fracture|drug=Cefazolin|dose=25mg/kg IV (max 2g) immediately then q8hrs x 3 doses|context=Pediatric Grade I & II|population=Pediatric}}
*Cephalosporin allergy: {{AntibioticDose|disease=Open fracture|drug=Clindamycin|dose=10mg/kg IV (max 900mg) immediately then q8hrs x 3 doses|context=Pediatric Grade I & II, allergy|population=Pediatric}}
=====Grade III=====
*{{AntibioticDose|disease=Open fracture|drug=Ceftriaxone|dose=50mg/kg IV (max 2g) x 1|context=Pediatric Grade III|population=Pediatric}} + {{AntibioticDose|disease=Open fracture|drug=Vancomycin|dose=15mg/kg IV (max 1g) then q12hrs x 2 doses|context=Pediatric Grade III|population=Pediatric}}
*Cephalosporin allergy: {{AntibioticDose|disease=Open fracture|drug=Aztreonam|dose=30mg/kg IV (max 2g) then q8hrs x 3|context=Pediatric Grade III, allergy|population=Pediatric}} + Vancomycin

Latest revision as of 13:16, 20 March 2026

Prophylactic Antibiotics for Open fractures

Initiate as soon as possible; increased infection rate when delayed[1]

Grade I & II Fractures Options

  • Cefazolin 2 g IV (immediately and q8 hours x 3 total doses) (Ancef)[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

Pediatric

Grade I & II
  • Cefazolin 25mg/kg IV (max 2g) immediately then q8hrs x 3 doses
  • Cephalosporin allergy: Clindamycin 10mg/kg IV (max 900mg) immediately then q8hrs x 3 doses
Grade III
  • Ceftriaxone 50mg/kg IV (max 2g) x 1 + Vancomycin 15mg/kg IV (max 1g) then q12hrs x 2 doses
  • Cephalosporin allergy: Aztreonam 30mg/kg IV (max 2g) then q8hrs x 3 + Vancomycin
  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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