Preemptive Antibiotic Administration in Open Fractures

Open fractures are severe injuries in which bone is exposed due to soft tissue damage or skin perforation. They account for approximately 3% of all fractures, with a high prevalence in the tibia (around 25%). In addition to significant functional and psychological burden, they carry a high risk of infection, particularly osteomyelitis. Due to the compromised soft tissue barrier, preemptive antibiotic prophylaxis plays a key role.Inadequate treatment duration carries risks: if this is too short, it prevents complete eradication of pathogens, while if too long this increases adverse effects and the development of resistance. In order to develop recommendations, a systematic PubMed search (last five years) was conducted, which identified 82 relevant studies.Antibiotic therapy is essential in open fractures, as the disrupted skin barrier substantially increases infection risk. Critical factors include drug selection, timing, and duration. Administration should begin immediately after trauma, ideally within 3 h.For Gustilo-Anderson type I/II fractures, a single dose of a cephalosporin (e.g., cefuroxime) is generally sufficient. In cases of allergy, clindamycin is recommended; for MRSA carriers, vancomycin is indicated.Type III fractures require therapy of up to 72 h but not longer than 24 h after wound closure. The standard regimen is a combination of a cephalosporin with gentamicin; alternatively, piperacillin/tazobactam may be used. In penicillin allergy, gentamicin or tobramycin is indicated.Thus, preemptive antibiotic therapy significantly reduces the risk of infection and is an essential component of open fracture management.