Clindamycin versus cloxacillin in the treatment of 240 open fractures. A randomized prospective study

Ann Chir Gynaecol. 1998;87(3):224-8.

Abstract

Background and aims: Systemic administration of antibiotics is recommended and has proved to lower infection rates in open fractures. However, no antibiotic has proved to be superior to any other.

Material and methods: In a prospective study 227 patients with 240 open fractures were randomized to receive either clindamycin or cloxacillin for infection prevention.

Results: The overall infection rate was 15%. Infection occurred in 9.3% of the clindamycin treated and in 20% of the cloxacillin treated fractures (p < 0.05). In the Gustillo Type I and II open fractures all the pathogens causing infection were gram-positive, while in the Type III open fractures 21 pathogens (57%) were gram-positive and 16 (43%) gram-negative. In the clindamycin treated fractures the infection rates in Type I and II open fractures were 3.3 and 1.8%, respectively, while in the cloxacillin group they were 20 and 3.8%, respectively. Both clindamycin and cloxacillin showed low effectiveness in the treatment of Type III open fractures, the highest infection rates being 75 and 67%, respectively (Type III B).

Conclusions: Clindamycin provides good antimicrobic coverage against the most common pathogens causing Type I and II open fracture infections. In the treatment of Type III open fractures additional administration of an antibiotic with good gram-negative coverage is recommended.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Clindamycin / therapeutic use*
  • Cloxacillin / therapeutic use*
  • Female
  • Fractures, Open / classification
  • Fractures, Open / complications
  • Fractures, Open / drug therapy*
  • Humans
  • Infection Control
  • Male
  • Middle Aged
  • Penicillins / therapeutic use*
  • Prospective Studies
  • Wound Infection / etiology
  • Wound Infection / prevention & control*

Substances

  • Anti-Bacterial Agents
  • Penicillins
  • Clindamycin
  • Cloxacillin