Template:Antibiotics Open Fracture: Difference between revisions
(Add pediatric dosing for open fracture prophylaxis) |
|||
| (23 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
===Prophylactic Antibiotics for [[Open fractures]]=== | ===Prophylactic Antibiotics for [[Open fractures|Open fractures]]=== | ||
'' | ''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>'' | ||
====[[Open_fracture|Grade I & II Fractures]] Options==== | ====[[Open_fracture|Grade I & II Fractures]] Options==== | ||
* | |||
* | *{{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> | ||
*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==== | ====[[Open_fracture#Grade_III|Grade III Fracture]] Options==== | ||
* | |||
*PLUS [[ | *{{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==== | ====Special Considerations==== | ||
*Concern for [[ | |||
*Fresh water wounds: [[fluoroquinolones]] OR 3rd/4th generation [[cephalosporin]] | *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/> | ||
*Saltwater wounds: [[doxycycline]] + [[ceftazidime]] OR [[fluoroquinolone]] | *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
- 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
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
- ↑ 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.