Once Daily High-Dose Gentamicin to Prevent Infection in Open Fractures of the Tibial Shaft: A Preliminary Investigation

George V. Russell, Jr., MD, Chantaé King, Carmen G. May, RN, BSN, MSN, Albert W. Pearsall IV, MD

Disclosures

South Med J. 2001;94(12) 

In This Article

Abstract and Introduction

Background. Cephalosporin and aminoglycoside antibiotics are currently recommended for infection prophylaxis in high-energy open tibial shaft fractures. We evaluated cephalosporin in conjunction with once daily high-dose gentamicin as prophylaxis against infection in Gustilo types II and III open tibial shaft fractures.
Methods. Sixteen patients were identified in whom once daily gentamicin dosing was used as part of an antibiotic prophylaxis regimen in patients with types II and III open tibial shaft fractures. Cefazolin (1 g) and gentamicin (5 mg/kg) were given before operation. Antibiotic therapy was continued for 48 hours after definitive wound closure. Monitoring for gentamicin toxicity consisted of blood urea nitrogen (BUN) and creatinine levels, gentamicin trough levels, and a daily query for signs of prodromal ototoxicity.
Results. Average time to fracture union was 8 months. One superficial and two deep infections were observed. No patient showed signs of nephrotoxicity or ototoxicity.
Conclusions. Our investigation suggests that this dosing regimen might be safe as prophylaxis against infection in open tibial shaft fractures and that it warrants further study.

The tibia is the most commonly fractured long bone, and many of these fractures are open.[1] The incidence of infection is noted to be 10 to 20 times higher in open tibial fractures than other open fractures.[2] Open tibial fractures are susceptible to infection due to several factors, including the high energy imparted to the leg, the poor blood supply of the tibia, and contamination of the fracture site at injury.[3] Several studies have shown that antibiotics significantly decrease the infection rate associated with open tibial shaft fractures.[2,4,5,6] It is generally agreed that a cephalosporin should be given in all open tibial shaft fractures. The addition of an aminoglycoside has been advocated for Gustilo types II and III open fractures[4,7] because of the higher incidence of gram-negative organisms contaminating these more severe open fractures.[2,4,8] Gentamicin is an aminoglycoside commonly used in prophylaxis against gram-negative colonization of open tibial fractures; however, institutional differences exist regarding the dose and dosing interval. A recent study has shown good results using a large daily dose of gentamicin in open fracture prophylaxis.[9] The purpose of this review was to investigate the efficacy of a 5 mg/kg daily dose of gentamicin in conjunction with a cephalosporin to prevent infection in operatively stabilized Gustilo types II and III open tibial shaft fractures.

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