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


South Med J. 2001;94(12) 

In This Article


Antimicrobial prophylaxis using once daily high-dose gentamicin in conjunction with cefazolin was found to be efficacious in our patients with high-energy open tibial shaft fractures. Once daily dosing of gentamicin permits higher serum peak concentrations and increased bactericidal action due to its concentration-dependent killing and the associated postantibiotic effect.[12,13,14,15] Once daily dosing of gentamicin leads to decreased renal accumulation of the drug, potentially decreasing the risk of nephrotoxicity.[16,17] No patient in this review had nephrotoxicity according to serologic monitoring of BUN and creatinine during hospitalization, and no patient showed any prodromal signs of ototoxicity.

We believe that in cases of open tibial shaft fractures, once daily high-dose gentamicin as prophylaxis against infection may be safely administered in patients who have a normal renal panel, are not pregnant, and have no renal disease, hearing loss, or granulocytopenia, without increased risk of nephrotoxicity or ototoxicity. On the basis of these results, we plan to initiate a prospective, multicenter study to further evaluate the role of once daily gentamicin for antimicrobial prophylaxis in open tibial shaft fractures.

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