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Antibiotic Prophylaxis for Open Fractures in the Emergency Department

Weant, Kyle A. PharmD, BCPS; Bailey, Abby M. PharmD, BCPS; Baum, Regan A. PharmD, BCPS; Justice, Stephanie B. PharmD, BCPS

Section Editor(s): Weant, Kyle A. PharmD, BCPS; Column Editor

Advanced Emergency Nursing Journal: January/March 2015 - Volume 37 - Issue 1 - p 23–29
doi: 10.1097/TME.0000000000000052

Emergency departments across the country regularly treat patients with traumatic injuries. One of the more common injuries that these patients present with is open fractures. Much of the morbidity associated with these fractures can be traced to the development of fracture-site infections that can lead to chronic osteomyelitis, impaired bone healing, and potential limb loss. Initial wound cultures in this setting are frequently positive, but they tend to demonstrate poor correlation with subsequent infections. The emergent management of open fractures includes a multipronged approach that includes stabilization, debridement, irrigation, soft tissue coverage, and systemic empiric antibiotics for prophylaxis. This review will discuss the etiology and factors associated with the development of infections in this setting, the use of empiric antibiotics, and the guidelines currently available.

Pharmacy Services, KentuckyOne Health, University of Louisville Hospital and Jewish Hospital, Louisville, Kentucky (Dr Weant); University of Kentucky HealthCare, and Departments of Pharmacy Services and Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington (Drs Bailey and Baum); and Department of Pharmacy, Charleston Area Medical Center, Charleston, West Virginia (Dr Justice).

Corresponding Author: Kyle A. Weant, PharmD, BCPS, Pharmacy Services, KentuckyOne Health, 530 S. Jackson St, Louisville, KY 40202 (

Disclosure: The authors report no conflicts of interest.

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