Can read freely here https://sethiortho.blogspot.com/ Choice of antibiotics Gustilo I Gustilo – II/III Fecal contamination Allergy to pecillin At the time of admission At the time of induction Continuation of antibiotics at Hospital At the time of skeletal fixation/ Soft tissue closure Gustilo grade III - A first-generation cephalosporin Gustilo grade III - a first-generation cephalosporin plus aminoglycoside Fecal or clostridial contamination - add Penicillin The antibiotic of choice is broad spectrum co-amoxiclav - 1.2 g 8 hourly A cephalosporin - cefuroxime 1.5 g 8 hourly Patients with anaphylaxis to penicillin Clindamycin (600 mg IV 6 hourly preoperatively) For those with lesser allergic reactions, a cephalosporin is considered to be safe and is the agent of choice Antibiotics should be administered as soon as possible after the injury certainly within 3h Should be continued until first debridement Antibiotics should be continued Gustilo grade 1 and II – 24hr of antibiotics following closure Gustilo grade III – 72 h after injury Or not more than 24 h following soft tissue coverage (whichever is the shorter) Should be given on induction of anaesthesia Gentamicin 1.5 mg/kg either vancomycin 1 g or teicoplanin 800 mg These should not be continued post operatively. The vancomycin infusion should be started at least 90 min prior to surgery

1. ANTIBIOTIC USAGE IN OPEN
FRACTURE MANAGEMENT
- BAPRAS GUIDELINES
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2. Introduction
Choice of antibiotics
1. Gustilo I
2. Gustilo – II/III
3. Fecal contamination
4. Allergy to pecillin
At the time of admission
At the time of induction
Continuation of antibiotics at Hospital
At the time of skeletal fixation / Soft tissue closure

3. Choice of antibiotics - Recommendations
Gustilo grade III - A first-generation cephalosporin
Gustilo grade III - a first-generation cephalosporin plus
aminoglycoside
Fecal or clostridial contamination - add Penicillin

4. Choice of antibiotics … Normally used
The antibiotic of choice is broad spectrum
– co-amoxiclav - 1.2 g 8 hourly
– A cephalosporin - cefuroxime 1.5 g 8 hourly

5. Choice of antibiotics
Patients with anaphylaxis to penicillin
Clindamycin (600 mg IV 6 hourly preoperatively)
For those with lesser allergic reactions, a cephalosporin is considered to be
safe and is the agent of choice

6. At the time of admission
Antibiotics should be administered as soon as possible after the
injury certainly within 3h
Should be continued until first debridement

7. At the time of first debridement
Should be administered
1. Co-amoxiclav (1.2 g)/ a Cephalosporin(such as cefuroxime
1.5 g)
2. With gentamicin (1.5 mg/kg)

8. Continuation of antibiotics at Hospital
Antibiotics should be continued
• Gustilo grade 1 and II – 24hr of antibiotics following closure
• Gustilo grade III –
• 72 h after injury
• Or not more than 24 h following soft tissue coverage (whichever is the
shorter)

9. At the time of skeletal stabilization/ Soft tissue closure
Should be given on induction of anaesthesia
1. Gentamicin 1.5 mg/kg
2. either vancomycin 1 g or teicoplanin 800 mg
These should not be continued post operatively.
The vancomycin infusion should be started at least 90 min prior to surgery.