Absence of potential soil or water contamination | Presence of potential soil contamination (in absence of water contamination) | Presence of water contamination | |
Gustilo-Anderson fracture type I or II* | |||
Preferred regimen |
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Alternative regimen for patients with beta-lactam hypersensitivity |
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Gustilo-Anderson fracture type III† | |||
Preferred regimen |
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| Fresh water contamination:
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Sea water contamination:
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Alternative regimen for patients with beta-lactam hypersensitivity |
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| Fresh water contamination:
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Sea water contamination:
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AUC: area under the 24-hour time-concentration curve; IV: intravenous.
* For type I and II open fractures, prophylactic antibiotics may be discontinued 24 hours after wound closure.
¶ For patients >120 kg, cefazolin dosing consists of 3 g IV every 8 hours.
Δ For patients at risk for methicillin-resistant Staphylococcus aureus (MRSA), gram-positive coverage should consist of vancomycin in place of cefazolin.
◊ For patients at risk for MRSA, vancomycin should be added to the regimen.
§ The vancomycin loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. Within this range, we use a higher dose for critically ill patients.
¥ Refer to the UpToDate topic on vancomycin dosing for sample nomogram.
‡ Refer to the UpToDate topic on vancomycin dosing for discussion of AUC-guided and trough-guided vancomycin dosing.
† For Gustilo type III open fractures, prophylactic antibiotics may be discontinued after 72 hours or within a day after soft tissue injuries have been closed.
** For patients unable to take fluoroquinolone (levofloxacin or ciprofloxacin), piperacillin-tazobactam plus doxycycline may be used as an alternative regimen.Do you want to add Medilib to your home screen?