Year: 2026 | Month: April | Volume: 13 | Issue: 4 | Pages: 214-224
DOI: https://doi.org/10.52403/ijrr.20260421
Antibiotic Prophylaxis in Gustilo-Anderson Grade II Open Fractures: A Literature Review
Panji Sananta1, Respati S. Dradjat1, Edi Mustamsir1, Annas Abdurahman Asmiragani1
1Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Brawijaya – Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia
Corresponding Author: Panji Sananta
ABSTRACT
Introduction: Infection is one of the most important complications of Gustilo-Anderson Grade II open fractures and may result in delayed union, nonunion, osteomyelitis, and functional impairment. Prophylactic antibiotics, combined with prompt surgical debridement, are a key component of treatment. However, the optimal regimen and duration of prophylaxis remain controversial.
Methods: A literature review was conducted using PubMed to identify studies published through December 2022. The search strategy was developed according to the PICO framework, focusing on patients with Grade II open fractures, prophylactic antibiotic administration, alternative regimens, and infection-related outcomes. After screening for articles meeting predefined inclusion and exclusion criteria, 8 articles were included. Data were synthesized narratively.
Results: First-generation cephalosporins, particularly intravenous cefazolin, were the most consistently recommended first-line prophylactic agents for Grade II open fractures. Clindamycin was the preferred alternative for patients with penicillin allergy. Early antibiotic administration, ideally within 1 hour of presentation, was associated with better infection prevention. Prophylaxis beyond 24 hours after definitive wound closure did not show additional benefit. Evidence supporting the routine use of aminoglycosides, fluoroquinolones, or other broad-spectrum agents was limited and inconsistent.
Conclusion: Current evidence supports early short-course intravenous cefazolin as the preferred prophylactic regimen for Gustilo-Anderson Grade II open fractures, with clindamycin as an appropriate alternative for patients with penicillin allergy. Prolonged antibiotic administration beyond 24 hours is not supported by the available evidence.
Keywords: anti-bacterial agents; fractures, open; anti-infective agents, local; surgical wound infection; osteomyelitis.
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