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Summary of Literature on Antibiotics in Open Fracture Management
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| Author, Year | Design or Sample Size | Intervention & Comparison | Outcomes |
| Harvey, 2018 | Retrospective, cohort study N=146 | Pharmacist participating during trauma resuscitation | 81% 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, 2014 | Pre/Post, cohort study N=174 | Updated Protocol Grade I/II fractures, cefazolin (clindamycin if allergy); Grade III fractures, ceftriaxone) vs 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, 2016 | Retrospective cohort study. | Administration of cefazolin plus gentamicin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxis | piperacillin/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. |