Single versus multiple doses of antibiotic prophylaxis in limb fracture surgery.

Abstract

BACKGROUND:

There is no consensus with regard to optimum prophylactic antibiotic regimen in orthopaedic fracture surgery.

OBJECTIVE:

A systematic review and meta-analysis were performed to determine if multiple-dose perioperative antibiotic prophylaxis is more effective than a single preoperative dose in the prevention of surgical wound infection in patients undergoing operative treatment of low-energy closed fractures.

DATA RESOURCES:

Medline, Medline in Process and other non-indexed citations, Embase, Cochrane database of systematic reviews and conference proceedings were searched.

REVIEW METHODS:

Studies were included if they were randomized or quasi-randomized trials comparing the results of a single antibiotic prophylaxis versus multiple doses of the same antibiotic in patients undergoing surgical fixation of closed fractures.

RESULTS:

Four studies were found to meet the searching criteria. The mean score for quality assessment of these studies was 16 (8-24 points). Only two out of four studies had detailed analysable data and therefore were included in the final analysis. 921 patients were pooled using a random-effects model. Compared to multiple-dose prophylaxis, administration of a single preoperative dose demonstrated no significant difference regarding the overall surgical site infection rate (risk ratio (RR) = 0.3, 95% confidence interval (CI): 0.07-1.25). Multiple-dose antibiotic prophylaxis is marginally more effective than single dose in reducing the incidence of deep surgical wound infection (risk ratio: 0.13, 95% CI: 0.02 to 0.99).

CONCLUSION:

There is lack of definite evidence that multiple-dose antibiotic prophylaxis is superior to single preoperative dose in low-energy closed fracture surgery.

• Authors: Stewart Morrison, Nathan White, Saeed Asadollahi, Justin Lade
• Journal: ANZ journal of surgery (ANZ J Surg) Vol. 82 Issue 12 Pg. 902-7 (Dec 2012) ISSN: 1445-2197 [Electronic] Australia
• PMID: 23057476 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (administration & dosage)
• Antibiotic Prophylaxis
• Fractures, Bone (surgery)
• Humans
• Randomized Controlled Trials as Topic