Template:Antibiotics Open Fracture: Difference between revisions
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===Prophylactic Antibiotics for [[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====
*[[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====
====[[Special:MyLanguage/Open_fracture|Grade I & II Fractures]] Options====
*[[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 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/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====
 
*[[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====
====Special Considerations====
*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]]
*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>
*Saltwater wounds ([[vibrio]]): [[doxycycline]] + [[ceftazidime]] OR [[fluoroquinolone]]
*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]]
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Revision as of 08:32, 23 January 2026

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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

  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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