For any delay in initial washout of open contaminated fracture: Start and continue antibiotics until first debridement and then for 48 hours following. Proceed with routine 48-hour perioperative antibiotics for each subsequent debridement.
*Consider substituting Vancomycin 15mg/kg IV every 12 hours for patients with:
**Gentamicin and Vancomycin require a pharmacokinetic consult for dosing.
Avoid fluoroquinolones for gram negative coverage as they offer no advantage, have potentially detrimental effect on fracture healing, and may result in higher infection rates.