Ceftriaxone Dosing for Open Fracture to Great Toe with Bone Exposure
For a crush injury to the great toe with an open laceration to bone, administer 2 grams of ceftriaxone intravenously once daily.
Rationale for 2-Gram Dosing
The FDA label specifies that for skin and soft tissue infections in adults, ceftriaxone should be dosed at 1-2 grams once daily depending on the type and severity of infection 1
An open fracture with bone exposure represents a severe, contaminated wound (Class III/IV surgical wound) requiring therapeutic rather than prophylactic antibiotic coverage 2
For serious infections beyond simple skin involvement, the FDA recommends the higher end of the dosing range (2 grams daily) 1
The 2-gram dose provides optimal tissue penetration for bone and deep soft tissue infections, which is critical when bone is exposed 3
Classification and Treatment Approach
This injury represents a contaminated wound requiring therapeutic antibiotics as an adjunct to surgical debridement, not simple prophylaxis 2
Antibiotics should be started immediately, as delays beyond 3 hours significantly increase infection risk 4, 5
The usual duration of therapy is 4-14 days depending on severity, with continuation for at least 2 days after signs and symptoms of infection have disappeared 1
Advantages of Ceftriaxone in This Context
Ceftriaxone offers once-daily dosing with 24-hour coverage, which is particularly advantageous for open fracture management 6
Recent evidence demonstrates that ceftriaxone is safe and effective for open extremity fractures without increasing infectious complications compared to traditional cefazolin regimens 6
Ceftriaxone provides broader gram-negative coverage than first-generation cephalosporins, which is beneficial for contaminated wounds 6, 7
Important Caveats
If the wound has gross contamination from soil or farm-related exposure, add penicillin to cover Clostridium species 4, 5
Ceftriaxone has no activity against Chlamydia trachomatis or MRSA; if these organisms are suspected based on clinical context, additional coverage is required 1
The 1-gram dose may be adequate for simple, clean wounds, but given bone exposure in a crush injury, the 2-gram dose is more appropriate for this severe presentation 1