From the Research
For a type I fracture, the recommended dose of ceftriaxone is 2 grams intravenously as a single dose, administered preoperatively and ideally within 3 hours of injury. This single dose is typically sufficient for prophylaxis in type I open fractures, though some clinicians may extend coverage for 24 hours (with an additional dose at 24 hours if needed) 1. Ceftriaxone is effective for this purpose because it provides good coverage against common skin flora, particularly gram-positive organisms like Staphylococcus aureus, which are the predominant contaminants in type I open fractures. The drug achieves high tissue concentrations and has a long half-life, making it suitable for single-dose prophylaxis 2. Some key points to consider when administering ceftriaxone for type I fractures include:
- Administering the antibiotic promptly after injury, as prophylaxis is most effective when given early 3
- Ensuring tetanus prophylaxis is also addressed based on the patient's immunization history
- Considering alternatives such as clindamycin (900 mg IV) or vancomycin (15 mg/kg IV) for patients with beta-lactam allergies
- Being aware that the use of ceftriaxone as monotherapy for antibiotic prophylaxis in lower extremity type III open fractures is not statistically different than the use of historic prophylactic regimens 1. It's also important to note that ceftriaxone offers a broader coverage and a decreased frequency of administration, making it a safe and effective alternative for open fracture extremity management 4.