Intravenous antibiotics for open fractures
Antibiotics for open fractures are an adjunct to meticulous wound débridement (see Pearl below).
Bacterial contamination is always present with open fractures. Bacterial count and infection rate can be significantly reduced by prompt administration of intravenous antibiotics, in combination with surgical débridement.
Most infecting bacteria, except in very dirty wounds, are typical skin flora. A first generation cephalosporin (e.g., cefazolin 1-2 grams/8 hours) is often used, except for patients with penicillin allergy.
For more severe open-fracture wounds, add an aminoglycoside (eg., gentamycin 80 mg/8-12 hours).
If “agricultural” contamination is present, high-dose intravenous penicillin is usually added (e.g., 5 million-10 million units/24 hours) and consider metronidazole.
They should be started as soon as the open fracture is diagnosed, but continued for only 2-3 days.
Pearl: “It is irrational to hope that a short course of antibiotic prophylaxis can cure fundamental surgical errors” (Geroulanos & Hell (1989) Antimicrobial Prophylaxis in Surgery).