A review of antibiotic prophylaxis for open fractures.

A review of the literature strongly supports the use of antibiotic prophylaxis in open fracture management. Because of their broad spectrum of activity, cephalosporins are the drugs of choice in cases of orthopaedic trauma. The extent of the injury determines the appropriate agent and the length of time it should be given. Patients with Type 1 or Type 2 fractures require only brief treatment (one preoperative and two postoperative doses) with an agent that has good antistaphylococci activity. Cephalothin, cefazolin, cefamandole or cefuroxime are recommended. Type 3 fractures present a much greater problem because of the risk of gram-negative infection. The marked activity of cefuroxime, cefamandole, and cefotaxime against these organisms recommends their use in such cases. Combination regimens with aminoglycosides require further study to define added efficacy and to define appropriate dosing regimens. We advocate that antibiotic prophylaxis should be given as soon as possible to all patients with open fractures and Type 3 fractures, and that prophylaxis should continue until 48 hours after adequate soft tissue coverage is achieved.