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The choice of antibiotic in open fractures in a teaching hospital in a developing country

T O Alonge1, S A Salawu, A T Adebisi

  • 1Department of Surgery, University College Hospital, Ibadan, Nigeria.

International Journal of Clinical Practice
|July 26, 2002
PubMed

Insights

Early antibiotic use in open fractures prevents osteomyelitis. This study identified effective, cost-efficient antibiotics like pefloxacin and ciprofloxacin for managing contaminated wounds, improving patient outcomes.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Open fractures present a high risk of contamination and subsequent osteomyelitis.
  • Current antibiotic selection for open fractures relied on empirical 'best guess' methods.
  • Environmental factors significantly impact microbial flora and antibiotic susceptibility in wound infections.

Purpose of the Study:

  • To determine the common microbial isolates in open fracture wounds.
  • To evaluate the in vitro efficacy of specific antibiotics against these isolates.
  • To inform an evidence-based antibiotic policy for open fracture management.

Main Methods:

  • Prospective study of 52 open fracture cases over six months.
  • Bacterial culture and sensitivity testing performed on wound samples.
  • Analysis of antibiotic efficacy and comparative cost-effectiveness.

Main Results:

  • Over 70% of open fracture wounds yielded positive bacterial cultures.
  • Staphylococcus aureus was the most frequent isolate (37.5%).
  • Pefloxacin, ciprofloxacin, and ceftriaxone demonstrated high efficacy against common isolates and were cost-effective.

Conclusions:

  • Established an evidence-based antibiotic regimen for open fracture management.
  • Recommended updating the hospital's antibiotic policy to include pefloxacin, ciprofloxacin, and ceftriaxone.
  • Improved treatment protocols for open fractures, reducing osteomyelitis risk and healthcare costs.

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