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Pharmacy & Acute Care University
Pharmacy & Acute Care University
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Open Fracture Antibiotics in Trauma

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  1. Background

    Introduction
  2. Epidemiology
  3. Etiology
  4. Classification
  5. Pathophysiology
  6. Clinical Manifestations
  7. Diagnostics
  8. Overview of Treatment
  9. Treatment and Management
    Type 1+2 Open Fracture Antibiotics
  10. Type 3 Open Fracture Antibiotics
  11. Tetanus Immunization
  12. Non-Pharmacologic Management
  13. Summary of Literature on Antibiotics in Open Fracture Management

Participants 396

  • Allison Clemens
  • April
  • ababaabhay
  • achoi2392
  • adhoward1
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Open Fracture Antibiotics in Trauma Type 1+2 Open Fracture Antibiotics
Lesson 9 of 13
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Type 1+2 Open Fracture Antibiotics

Antibiotics Used In Type 1+2 Open Fractures

Cefazolin

  • Mechanism of Action: Bactericidal; inhibition of bacterial cell wall synthesis
  • Dose: Intravenous, 2g (3g if >120 kg), q8h
  • Pharmacokinetics: Half-life is approximately 1.8 hours following IV administration
  • Contraindications: Cephalosporin hypersensitivity or cephamycin hypersensitivity
  • Adverse Effects: Hypersensitivity reactions, C. difficile-associated diarrhea, central line infections, nosocomial pneumonia secondary to resistant and/or Gram-negative bacteria, white patches or sores in the mouth or lips
  • Pearls: Preferred initial antibiotic for open fractures; Duration: 24 hours
  • Spectrum of Activity
    • Gram-positive aerobes
      • Staphylococcus aureus (including beta-lactamase producing strains)
      • Staphylococcus epidermidis
      • Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus pneumoniae and other strains of streptococci
    • Gram-negative bacteria
      • Moraxella catarrhalis, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis

Metronidazole

  • Mechanism of Action: Bactericidal; inhibition of bacterial cell wall synthesis
  • Dose: Intravenous, 500mg, q8h
  • Pharmacokinetics: Half-life is 7.3 ± 1.0 after a single 500mg IV dose in healthy subjects
  • Contraindications: Hypersensitivity to metronidazole or other nitroimidazole derivatives
  • Adverse Effects: Hypersensitivity reactions, irritability, sleep problems, depression, headache, rash, constipation, nausea, mouth sores
  • Pearls: Preferred antibiotic for Type I and II open fracture with soil or feces contamination (with or without Penicillin G 4 million units IV, q4h); Duration: 24 hours
  • Spectrum of Activity
    • Anaerobic Gram-negative bacilli:  Bacteroides fragilis, Bacteroides species, Fusobacterium spp., Porphyromonas spp., Prevotella spp.
    • Anaerobic Gram-positive bacilli:  Clostridium spp.
    • Anaerobic cocci:  Peptostreptococcus species, Veillonella species
    • Protozoa:  Blastocystis hominis, Entamoeba histolytica, Giardia lamblia, Trichomonas vaginalis

Clindamycin

  • Mechanism of Action: Bacteriostatic; binds to the 50s ribosomal subunit of bacteria
  • Dose: Intravenous, 900 mg, q8h
  • Pharmacokinetics: Elimination half-life of clindamycin is about 3 hours in adults and 2.5 hours in children
  • Contraindications: Hypersensitivity to preparations containing clindamycin or lincomycin, Myasthenia gravis, Crohn’s disease, ulcerative colitis, severe liver and renal impairment
  • Adverse Effects: Hypersensitivity reactions, C. difficile-associated diarrhea, nausea, vomiting, stomach pain, mild skin rash, vaginal itching or discharge
  • Pearls: Preferred antibiotic for severe beta-lactam allergy
  • Spectrum of Activity
    • Streptococcus spp., Staphylococcus spp., H. influenzae, M. catarrhalis, Bacteroides spp., (Clostridia spp.of variable susceptibility) Prevotella spp., Fusobacterium spp., Veillonella spp., Chlamydia trachomatis

Vancomycin

  • Mechanism of Action: Bactericidal; Inhibits cell wall synthesis by binding to the D-Ala-D-Ala terminal of the growing peptide chain during cell wall synthesis
  • Dose: Intravenous, 15mg/kg, q12h
  • Pharmacokinetics: Half-life is approximately 1.8 hours following IV administration
  • Contraindications: Systemic mastocytosis, low levels of neutrophils, patients with kidney disease
  • Adverse Effects: Hypersensitivity reactions, bitter taste to the tongue, reddish rash on face and upper body (red neck or red man syndrome related to infusion rate), low blood pressure, eosinophilia, rash, bloody urine or stool, tinnitus
  • Pearls: Preferred initial antibiotic for patients with known MRSA colonization and/or severe PCN allergy
  • Spectrum of Activity
    • Staphylococcus aureus (vancomycin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae, Streptococcus spp., Enterococcus spp. (Vancomycin-susceptible), C. jeikeium, Clostridium spp., L. monocytogenes, Actinomyces

Levofloxacin

  • Mechanism of Action: Bactericidal; inhibition of bacterial topoisomerase IV and DNA gyrase
  • Dose: Intravenous, 500mg, q24h
  • Pharmacokinetics: Average terminal elimination half-life of levofloxacin is 6-8 hours
  • Contraindications: Low blood glucose, diabetes, low seizure threshold, low blood potassium, pseudotumor cerebri
  • Adverse Effects: Increased pressure in the skill, tinnitus, severe headaches, nausea, dizziness, psychosis, convulsions, tremors, confusion, agitation
  • Pearls: Most bactericidal quinolone; Preferred antibiotic for patients with severe Penicillin allergy with soil or feces contamination on injury (with Metronidazole 500 mg IV q8h)
  • Spectrum of Activity
    • Gram positive bacteria:  methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pneumoniae, Listeria monocytogenes
    • Gram negative bacteria:  Enterobacteriaceae, H. influenzae, other Haemophilus spp., N. gonorrhoeae, N. meningitides, M. catarrhalis, P. aeruginosa, Stenotrophomonas maltophilia, S. maltophilia
    • Atypicals:  Legionella pneumophilia