Antimicrobial prophylaxis in open lower extremity fractures

ntimicrobial prophylaxis in open lower extremity fractures Evidence to Practice (4763) Total Article Views Authors: Amanda Anderson, April D Miller, P Brandon Bookstaver Published Date February 2011 Volume 2011:3 Pages 7 - 11 DOI: http://dx.doi.org/10.2147/OAEM.S11862 Amanda Anderson, April D Miller, P Brandon Bookstaver Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA Date of preparation: November 2010 Conflict of interest: PBB: Research grant support from Cubist Pharmaceuticals; Merck and Co., Inc.; Astellas US Pharma Clinical question: Based on the grade of open fracture, which antibiotic should be selected for antimicrobial prophylaxis, and what is the optimal timing and duration of administration? Results: For Grade I and II open fractures, a first-generation cephalosporin (eg, cefazolin) should be administered within 3 hours of initial injury and be continued for 24 hours after initial injury. Grade III open fractures require coverage with an aminoglycoside in addition to a first-generation cephalosporin within 3 hours of initial injury, and antibiotics should be continued for 48–72 hours after initial injury but no more than 24 hours after wound closure. If a fracture is at risk of contamination with clostridium species, such as a farm-related injury, penicillin should be added to the antibiotic regimen. Implementation: Pitfalls to avoid when using antibiotics for infection prophylaxis in open fractures include utilizing cultures immediately postinjury to direct choice of agent for antimicrobial prophylaxis, because infecting pathogens do not typically correlate to pathogens initially cultured after injury; failure to consider patients’ medication allergy history or reconcile allergy records; and failure to obtain a thorough history to determine injury exposure (eg, farm, water).