Tibial Fractures (Open)

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Antibiotic prophylaxis for open tibial fractures

1. Antibiotics should be administered as soon as possible after the injury and certainly within 3 hours

2. The antibiotic of choice is co-amoxiclav (1.2g) or cefuroxime (1.5g) 8 hourly and continued until wound debridement (excision)

3. At the time of debridement, co-amoxiclav (1.2g) and gentamicin (7mg/kg) should be administered and co-amoxiclav (1.2g) 8 hourly continued until soft tissue closure or for a maximum of 72 hours, whichever is sooner

4. When skeletal fixation and definitive soft tissue reconstruction is undertaken, gentamicin (7mg/kg, with appropriate adjustment in the elderly or those with renal impairment) and either vancomycin (1g) or teicoplanin (800mg) should be used at induction of anaesthesia

5. Patients with anaphylaxis to penicillin, should receive clindamycin (600mg iv pre-op/qds). For those with lesser allergic reactions cefuroxime is considered to be safe and is the agent of choice.