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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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martes, 13 de septiembre de 2016

Antibiotics for Facial Fractures

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Taming The SRU - September 12, 2016
"THE ISSUE
The orthopedic literature has shown strong evidence that open fractures are at risk for infectious complications (leading to osteomyelitis, deep space infections, and non-union of fractures), and supports the use of antibiotics for open fractures. Theoretically, similar risks exist with facial fractures that extend into adjacent sinus and oral cavities, due to the bacterial flora within these spaces...
BOTTOM LINE
Though the literature is mixed, Drs. Hom and Collar would suggest the following, but are happy to talk about things on a case-by-case basis, as every patient is different:
  • Give antibiotics for: 
    • Facial fractures communicating with open wounds of the skin
    • Mandibular fractures that extend into the oral cavity (including the dentoalveolar ridge)
  • Strongly consider antibiotics for:
    • Orbital wall fractures with extension into the maxillary, ethmoid, or frontal sinus
  • Consider antibiotics for:
    • Frontal sinus fractures
    • Nasal bone fractures with mucosal disruption (leading to epistaxis)
    • Orbital wall fractures that do not extend into the sinuses (lateral)
  • No need for antibiotics in isolated:
    • Closed nasal fractures without septal mucosal disruption
    • Closed zygomatic arch fractures
    • Closed mandibular condyle fractures (since these typically do not communicate with the oral cavity)
    Antibiotic of choice: Augmentin BID x 1 week, or Clindamycin for one week in those with penicillin allergies."