Abstract
Objective
To determine the difference in infection rate between 24 h versus five days of prophylactic antibiotic use in management of Gustilo II open
tibia fractures.
Design
Unblinded randomized control trial.
Setting
Accident and Emergency, orthopedic wards and outpatient clinics at Kenyatta National
Hospital (KNH).
Patients
The study involved patients aged 18–80 years admitted through accident and emergency
department with Gustilo II traumatic open tibia fractures.
Intervention
Patients were randomized into either 24 hour or five day group and antibiotics started for 24 hours or five days after surgical debridement. The wounds were exposed and scored
using ASEPSIS wound scoring system for infection after 48 h, 5 days and at 14 days.
Outcome measures
The main outcomes of interest were presence of infection at days 2, 5 and 14 and effect
of duration to antibiotic administration on infection rate.
Results
There was no significant difference in infection rates between 24-hour and 5-day groups
with infection rates of 23% (9/40) vs. 19% (7/37) respectively (p = 0.699). The infection rate was significantly associated with time lapsed before administration
of antibiotics (p = 0.004).
Conclusion
In the use of prophylactic antibiotics for the management of Gustilo II traumatic
open tibia fractures, there is no difference in infection rate between 24 hours and five days regimen but time to antibiotic administration correlates with
infection rate. Antibiotic use for 24 hours only has proven adequate prophylaxis against infection. This is underlined in
our study which we hope shall inform practice in our setting. A larger, more appropriately
controlled study would be useful.
Keywords
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Article info
Publication history
Published online: July 19, 2016
Accepted:
July 7,
2016
Identification
Copyright
© 2016 Elsevier Ltd. All rights reserved.
