Antibiotics in Open Fractures of the Distal Phalanx?

Abstract

A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended.

Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery

“…Five summary-of-findings tables and five clinical summary tables were created corresponding to clinical sections of Plastic and Reconstructive Surgery (Breast, Cosmetic, Hand/Peripheral Nerve, Pediatric/Craniofacial, and Reconstructive sections). Of the 138 included RCTs, 18 were breast (Tables 2 and 3), 10–27 10 cosmetic (Tables 4 and 5), 28–37 21 hand/peripheral nerve (Tables 6 and 7), 38–58 61 pediatric/craniofacial (Tables 8 and 9), 16,59–118 and 41 reconstructive (Tables 10 and 11). 16,28,38–42,54–56,119–149 Forest plots are provided for all comparisons.…”

“…Of the 138 included RCTs, 18 were breast (Tables 2 and 3), 10–27 10 cosmetic (Tables 4 and 5), 28–37 21 hand/peripheral nerve (Tables 6 and 7), 38–58 61 pediatric/craniofacial (Tables 8 and 9), 16,59–118 and 41 reconstructive (Tables 10 and 11). 16,28,38–42,54–56,119–149 Forest plots are provided for all comparisons. ( See Figure, Supplemental Digital Content 3 , which shows forest plot comparisons, http://links.lww.com/PRS/G324.)…”

“…43,51 Postoperative antibiotics for 5 to 6 days likely do not decrease SSI compared with placebo (RR, 0.56; 95% CI, 0.32 to 0.99; 622 participants; three studies; I 2 = 21%; moderate-certainty evidence). 51,54,55…”

Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study

“…SSIs were diagnosed in 5.1% of patients who received antibiotic prophylaxis and in 7.7% of controls (OR 0.54, 95% CI 0.30-0.96, p = 0.04). On the contrary, when nonrandomized controlled studies were added to the evaluation, the difference between treated and untreated patients was not more significant (4.9% vs. 5.7%, p = 0.76, 95% CI 0.49-1.17, p = 0.13) [18][19][20][21][22][23][24][25][26][27]. In head and neck surgery, a relevant reduction of SSI incidence was shown when only randomized (16.4% vs. 41.9%; OR 0.23, 95% CI 0.11-0.46, p < 0.0001) and randomized plus nonrandomized studies (12.2% vs. 25.7%; 95% CI 0.12-0.54; p < 0.0001) were analyzed [28][29][30][31][32][33][34][35], leading to the conclusion that relevance of antibiotic prophylaxis could not be established [10].…”

Principles of management of hand fractures

“…This is due to the high risk of contamination of the deep tissues. Sloan et al (1987) carried out a prospective trial on 85 patients and found that the infection rate was less than 3% in patients who received antibiotic therapy compared to 30% in the group without antibiotics. More recently, Ng et al (2014) showed that the administration of intravenous antibiotics was the most significant factor in preventing infection in open fractures.…”