A prospective, randomized study was performed on 75 Gustilo Grades II and III
open fractures to determine the efficacy of once daily, high dose
aminoglycoside therapy, compared with more conventional dosing, in reducing the
infection rate when used in conjunction with an aggressive operative treatment protocol. All patients enrolled in the study were treated with immediate irrigation,
debridement, operative stabilization of the fracture, and 1 g of
cefazolin every 8 hours. At the time of admission patients were randomized to two groups. Patients in Group I received
gentamicin 5 mg/kg divided into twice daily doses, and patients in Group II received
gentamicin 6 mg/kg given once daily. All patients were monitored for renal toxicity and observed for radiographic and clinical signs of
infection until fracture union. The results of the study revealed no statistically significant difference between once daily, high dose versus divided, low dose
gentamicin in
infection rates. Thus, daily dosing of
gentamicin was found to be safe, effective, and cost efficient in the treatment of
open fractures when combined with a
cephalosporin and aggressive operative
debridement and stabilization.