Template:Antibiotics Open Fracture: Difference between revisions

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===Prophylactic Antibiotics for [[Open fractures|Open fractures]]===
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===Prophylactic Antibiotics for [[Special:MyLanguage/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>''
''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====


====[[Special:MyLanguage/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/>


*[[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>
====[[Open_fracture#Grade_III|Grade III Fracture]] Options====
*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>


*{{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:MyLanguage/Open_fracture#Grade_III|Grade III Fracture]] Options====
====Special Considerations====


*[[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>
*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/>
*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>
*Fresh water wounds: [[fluoroquinolones|fluoroquinolones]] OR 3rd/4th generation [[cephalosporin|cephalosporin]]
 
*Saltwater wounds ([[vibrio|vibrio]]): [[doxycycline|doxycycline]] + [[ceftazidime|ceftazidime]] OR [[fluoroquinolone|fluoroquinolone]]
 
====Special Considerations====


*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>
====Pediatric====
*Fresh water wounds: [[Special:MyLanguage/fluoroquinolones|fluoroquinolones]] OR 3rd/4th generation [[Special:MyLanguage/cephalosporin|cephalosporin]]
=====Grade I & II=====
*Saltwater wounds ([[Special:MyLanguage/vibrio|vibrio]]): [[Special:MyLanguage/doxycycline|doxycycline]] + [[Special:MyLanguage/ceftazidime|ceftazidime]] OR [[Special:MyLanguage/fluoroquinolone|fluoroquinolone]]
*{{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}}
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*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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