Clindamycin versus cloxacillin in the treatment of 240 open fractures. A randomized prospective study.
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.
Vasenius
J
J
Department of Hand Surgery, Helsinki University Central Hospital, Finland. jarkko.vasenius@kolumbus.fi
Tulikoura
I
I
Vainionpää
S
S
Rokkanen
P
P
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*
D000900:Anti-Bacterial Agents; D010406:Penicillins; D002981:Clindamycin; D003023:Cloxacillin