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

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.