title: Antibiotics in the treatment of low-velocity gunshot-induced fractures: a systematic literature review.
abstract: BACKGROUND
  Low-velocity gunshots are often associated with extremity fractures. There is no consensus, however, on the use of antibiotics for these injuries.
  
  
  OBJECTIVE
  We performed a literature review to answer the following questions: (1) Are antibiotics needed for the treatment of these fractures? (2) Is gram-negative coverage necessary? (3) How long should antibiotics be administered? And (4) which is the optimal administration route?
  
  
  METHODS
  We conducted a MEDLINE(®) search and found only two relevant prospective, randomized studies. Further searches identified all case series with information on the use of antibiotics in gunshot fractures. In total, 33 studies provided enough data to answer the study questions. An assessment of the quality of the identified studies was performed. Twenty-three studies met at least ½ of the quality items of the assessment tool.
  
  
  RESULTS
  Antibiotics did not significantly reduce the infection rate for fractures treated nonoperatively (1.7% with antibiotics versus 5.1% without) with the numbers available. There was no significant difference in infection rates when gram-negative coverage was added, either in nonoperatively treated fractures (1.7% versus 2.8%) or in operatively treated fractures (0% versus 2.5%). Duration of antibiotic administration did not significantly affect the infection rate. No difference was found between intravenous and oral antibiotic administration for nonoperatively treated fractures.
  
  
  CONCLUSIONS
  This literature review could not demonstrate a significant benefit with the use of antibiotics for low-velocity gunshot fractures treated nonoperatively; however, the statistical power for these comparisons was low in the available literature, which is insufficiently strong to recommend a treatment. Gram-negative coverage did not alter the infection rates in gunshot fractures, nor did longer duration of antibiotic administration. For fractures treated nonoperatively, oral antibiotics are as efficacious as intravenous antibiotics.
authors: Department of Orthopaedic Surgery, University of Southern California, Keck School of Medicine, 1200 N State Street, GNH-3900, Los Angeles, CA, 90033, USA.
authors: Efthymios
authors: E
authors: Papasoulis
authors: Michael J
authors: MJ
authors: Patzakis
authors: Charalampos G
authors: CG
authors: Zalavras
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy*; D014948:Wounds, Gunshot / Q000150:complications / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents