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3/30/22 cb New Antibiotic Indication
March 30, 2022
From: "Caitlin Bowman" <caitlin.bowman@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Cc: "Jonathan Edwards" <jonathan.edwards@hhsys.org>, "Madeline Belk" <madeline.belk@hhsys.org>
Sent: Wednesday, March 30, 2022 1:12:58 PM
Subject: New Antibiotic Indication
Good afternoon Pharmacists,
Recently a new indication of "Prophylaxis, Open-Fracture" has been added to the following antibiotics: cefazolin, clindamycin, ceftriaxone, levofloxacin, metronidazole, & piperacillin-tazobactam. Providers have been instructed to use this new indication when patients present with open-fractures as antibiotics are indicated immediately, prior to any surgery. Antibiotics with this indication are typically continued until surgery can be performed.
For example, a patient presents with an open-fracture on a Friday, but surgery is not scheduled until Monday. The provider would select the indication of "Prophylaxis, Open-Fracture" on the antibiotic chosen, so that the patient will start receiving antibiotics immediately on Friday. The antibiotic would be continued until the patient undergoes the surgical procedure.
The specific antibiotic regimen is chosen at the provider's discretion based off of the type of fracture and any possible contamination. Some common regimens (assuming normal renal function) for adult patients with open-fractures include:
- Type I and II Fracture:
- Cefazolin 2 g (3 g if > 120kg) IV q8h
- Severe beta-lactam allergy: Clindamycin 900mg IV q8h
- Type III Fracture:
- No gross contamination:
- Ceftriaxone 2g IV q24h
- Severe Beta-lactam allergy: Clindamycin 900 mg IV q8h + levofloxacin 500 mg IV q24h
- Contamination with soil or fecal material:
- Preferred: Ceftriaxone 2 g IV q24h + metronidazole 500 mg IV q8h
- Severe Beta-lactam allergy: Levofloxacin 500 mg IV q24h + metronidazole 500 mg IV q8h
- Contamination with standing water:
- Preferred: Piperacillin/tazobactam 3.375 g IV q8h
- Severe Beta-lactam allergy: Levofloxacin 500 mg IV q24h + metronidazole 500 mg IV q8h
The indication of "Prophylaxis, Surgical" will still be utilized for antibiotics that are administered post-operatively. Please contact AMT (7-4200) with any questions!