In this installment of our NNT series we examine the hard numbers behind two standard practices: early antibiotic use for open fractures and steroids for croup.


{early antibiotics}

by Dan Runde, MD and David H Newman, MD
Q: Does early antibiotic use reduce wound infections in open fractures?
A: Yes


(not documented in studies)

Green: Proven to benefit

Take Home Message: Early antibiotics prevent wound infections in open fractures.

Details: The use of early antibiotics in the treatment of open limb fractures has long been considered standard in the United States and most other developed nations. Open fractures are considered, by definition, contaminated. Use of systemic antibiotics as part of the initial treatment of these fractures is aimed at preventing contamination from developing into more serious complications such as osteomyelitis, abscess. This review found that early antibiotic use helped prevent early infections in open limb fractures (ARR 6.5%, NNT = 16).

Caveats: The data presented by this review are very limited. The primary outcome of “early infection” was heterogeneous across the 8 included studies, which were underpowered and unable to evaluate outcomes like mortality, amputation, osteomyelitis, delayed union or non-union, and length of hospital stay. Interestingly, antibiotics for open finger fractures was equivocal, and limited data were unable to demonstrate a benefit (3 trials with N = 367). None of the studies reported side effects, or antibiotic resistance. And, as one might expect, only one was performed within the last 20 years. In summary, while this evidence is not robust or valid enough to prove benefit it seems wise to utilize antibiotic treatment for open non-finger fractures unless better data suggest differently.

Data source: Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev.

continue reading for the NEXT QUESTION Q: Do glucocorticoids prevent return visits, admissions, or need for additional treatment?



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