Lesson 13 of13
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Summary of Literature on Antibiotics in Open Fracture Management

Jimmy November 20, 2021
Author, YearDesign or Sample SizeIntervention & ComparisonOutcomes
Harvey, 2018Retrospective, cohort study N=146Pharmacist participating during trauma resuscitation81% vs 47% pharmacist vs. no pharmacist present   Median door-to-antibiotic time was 4 minutes in the PHARM group vs 20 minutes in the NO-PHARM group   For Type III fractures, antibiotic selection met guideline recommendations in 74% of patients in the PHARM group vs 29% in the NO-PHARM group
Rodrigeuz, 2014Pre/Post, cohort study N=174 Updated Protocol Grade I/II fractures, cefazolin (clindamycin if allergy); Grade III fractures, ceftriaxone)


Cefazolin 1-2 g load then
1 g IV every 8 h for 48 h +
Gentamicin 1-2 mg/kg
(based on ideal body
weight IV every 8 h
for 48 h)
After protocol implementation, the use of aminoglycoside and glycopeptide antibiotics was significantly reduced (53.5% vs. 16.4%, p = 0.0001)

The skin and soft tissue infection rate per fracture event was 20.8% before and 24.7% after protocol implementation (p = 0.58). There was no statistically significant change after stratification for fracture grade
Redfern, 2016Retrospective cohort study. Administration of cefazolin plus gentamicin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxispiperacillin/tazobactam as compared with cefazolin plus gentamicin for antibiotic prophylaxis in patients with type 3 open fractures showed similar rates of SSI, nonunion, mortality, and rehospitalization at 1 year after injury
Shawar, 2016 Retrospective cohort study.  Administration of cefazolin plus tobramycin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxis There was no difference in the composite AEs in the piperacillin/tazobactam compared with the tobramycin group. However, SSI within 30 and 60 days was significantly more common with tobramycin.