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. Author manuscript; available in PMC: 2019 Nov 1.
Published in final edited form as: Emerg Med Clin North Am. 2018 Sep 6;36(4):751–766. doi: 10.1016/j.emc.2018.06.006

TABLE 4.

Antibiotic prophylaxis for open fracture by Gustilo-Anderson classification [79]

Type Description Infection rate
[71-73]		 Antibiotic
I Open fracture with wound ≤1 cm and clean 0-2% Cefazolin 2 g IVa,b
II Open fracture with wound >1 cm without extensive soft tissue injury, flap, or avulsion 2-10%
III Open segmental fracture with wound >10 cm with extensive soft tissue injury or traumatic amputation 10-50% Cefazolin 2 g IVa + gentamicin 5 mg/kg IV (adjusted body weight)c
a

If actual body weight ≥120 kg, consider 3 g.

b

If penicillin allergy, may substitute with vancomycin 15 mg/kg IV (actual body weight).

c

Antibiotic prophylaxis directed against Gram-negative bacteria (including Pseudomonas aeruginosa) remains controversial.[78-80] Institution-specific protocols and/or infectious disease consultation can help guide safe and appropriate Gram-negative coverage, particularly in the setting of impaired renal function.