title: Clindamycin versus cloxacillin in the treatment of 240 open fractures. A randomized prospective study.
abstract: OBJECTIVE
  Systemic administration of antibiotics is recommended and has proved to lower infection rates in open fractures. However, no antibiotic has proved to be superior to any other.
  
  
  METHODS
  In a prospective study 227 patients with 240 open fractures were randomized to receive either clindamycin or cloxacillin for infection prevention.
  
  
  RESULTS
  The overall infection rate was 15%. Infection occurred in 9.3% of the clindamycin treated and in 20% of the cloxacillin treated fractures (p < 0.05). In the Gustillo Type I and II open fractures all the pathogens causing infection were gram-positive, while in the Type III open fractures 21 pathogens (57%) were gram-positive and 16 (43%) gram-negative. In the clindamycin treated fractures the infection rates in Type I and II open fractures were 3.3 and 1.8%, respectively, while in the cloxacillin group they were 20 and 3.8%, respectively. Both clindamycin and cloxacillin showed low effectiveness in the treatment of Type III open fractures, the highest infection rates being 75 and 67%, respectively (Type III B).
  
  
  CONCLUSIONS
  Clindamycin provides good antimicrobic coverage against the most common pathogens causing Type I and II open fracture infections. In the treatment of Type III open fractures additional administration of an antibiotic with good gram-negative coverage is recommended.
authors.affiliation: Department of Hand Surgery, Helsinki University Central Hospital, Finland. jarkko.vasenius@kolumbus.fi
authors.forename: J
authors.initials: J
authors.lastname: Vasenius
authors.forename: I
authors.initials: I
authors.lastname: Tulikoura
authors.forename: S
authors.initials: S
authors.lastname: Vainionpää
authors.forename: P
authors.initials: P
authors.lastname: Rokkanen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use*; D003023:Cloxacillin / Q000627:therapeutic use*; D005260:Female; D005597:Fractures, Open / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use*; D011446:Prospective Studies; D014946:Wound Infection / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002981:Clindamycin; D003023:Cloxacillin