Orthopaedics

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Type III

Indications

First line treatment

  • Cefazolin 2g IV every 8 hours* plus Gentamicin 6mg/kg IV every 24 hours**

Penicillin alternative

  • Vancomycin 15 mg/kg IV every 12 hours plus Gentamicin 6mg/kg IV every 24 hours**

Duration

  • 48 hours after EACH debridement until final wound coverage
    • Does not need to be given continuously until coverage, only for 48 hours after each debridement. 

Notes

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:

  • Known MRSA colonization
  • Previous MRSA infections
  • MRSA risk factors
  • Proximity to indwelling medical device

**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.

 

Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.