Choice and duration of antibiotics in open fractures.

Open fracture wounds are contaminated wounds, and wide spectrum antibiotic therapy effective against both gram-positive and gram-negative organisms is recommended. Combination therapy has been shown to be effective in significantly reducing the infection rate in open fractures. For type I and II open fracture wounds, 3 days of antimicrobial therapy is recommended; for type III open fracture wounds, 5 days of treatment is recommended. When secondary procedures are performed, such as bone grafting, open reduction and internal fixation, soft tissue transfers, and other procedures involving the fracture site, an additional 72 hours of therapy is recommended. When antibiotic therapy is given after the initial period, antimicrobials administered should be selected on the basis of the culture and sensitivities of the original infecting organisms.