What antibiotic is recommended for a nasal fracture?

Antibiotic Recommendations for Nasal Fracture

Routine prophylactic antibiotics are not recommended for uncomplicated nasal bone fractures managed by closed reduction. 1, 2, 3

Evidence-Based Approach to Nasal Fracture Management

Closed Nasal Fractures

• Multiple recent studies demonstrate no benefit of prophylactic antibiotics for closed nasal fractures:
  • A 2021 retrospective study of 373 patients showed no surgical site infections regardless of antibiotic use 1
  • A 2023 study found no difference in infection rates between antibiotic and non-antibiotic groups (2.0% vs 2.2%) 2
  • A 2019 prospective study showed no clinically significant infections in patients without antibiotic prophylaxis 3

Open Nasal Fractures

For open nasal fractures, antibiotic selection should follow guidelines for open fractures:

• For minor contamination (Gustilo-Anderson Grade I/II open fractures):

  • First-line: Cefazolin 1g IV 4
  • Alternative (if beta-lactam allergy): Clindamycin 600-900mg IV 4
  • Duration: 3 days of antibiotic therapy 4

• For severe contamination (Gustilo-Anderson Grade III wounds):

  • Duration should be extended to 5 days 4

Special Considerations

Timing of Administration

• For open fractures requiring antibiotics, administration should occur as soon as possible after injury 4
• Delayed antibiotic administration should be avoided in cases where antibiotics are indicated 4

Nasal Packing

• Studies show that the presence of nasal packing does not increase infection risk enough to warrant prophylactic antibiotics 1, 3
• Bacterial colonization of nasal packing occurs regardless of antibiotic use 3

Potential Harms of Unnecessary Antibiotics

• Routine use of antibiotics can lead to:
  • Development of resistant bacterial strains
  • Increased medical costs
  • Patient inconvenience
  • Risk of antibiotic-related adverse effects 3

Exceptions and Special Cases

• Consider antibiotics for:
  • Patients with significant comorbidities (immunocompromised)
  • Contaminated wounds
  • Fractures involving the frontal sinus (higher risk of serious infections) 5
  • Cases requiring delayed surgical intervention (>48 hours after injury) 5

Key Points for Practice

• Do not routinely prescribe antibiotics for simple closed nasal fractures
• Reserve antibiotics for open fractures, using appropriate agents based on fracture classification
• Focus on proper wound care and surgical technique rather than relying on antibiotics
• Consider patient-specific risk factors when making decisions about antibiotic use

The evidence clearly demonstrates that the routine use of perioperative antibiotics is unnecessary in uncomplicated nasal bone fracture surgery, and this practice should be avoided to prevent antibiotic overuse.