Simpson et al listed criteria for administration of antibiotics to patients with gunshot wounds including those with fracture. Appropriate use of antibiotics can reduce complications in these patients. The authors are from Howard University Hospital in Washington, D.C.
All patients should receive standard care with wound debridement, removal of any foreign debris and fracture stabilization. All patients should also receive tetanus prophylaxis.
Indications for antibiotic prophylaxis:
(1) fracture caused by high velocity gunshot: minimum 48 hours IV antibiotics (cephalosporin, plus an aminoglycoside if cavitary lesion or extensive soft tissue damage)
(2) fracture associated with shotgun wound: minimum 48 hours IV antibiotics (cephalosporin, plus an aminoglycoside if extensive soft tissue damage)
(3) intra-articular gunshot wounds: minimum 24 to 48 hours of IV antibiotics
(4) gunshots injuries to hand or foot
(5) gunshot involving the distal tibia (around the ankle): minimum of 24 hours third generation cephalosporin IV
where:
• A high velocity missile is one traveling at > 2,000 feet per second.
Indications for longer antibiotic therapy:
(1) any wound with gross contamination: 1-2 weeks of broad-spectrum antibiotics (third generation cephalosporin plus an aminoglycoside plus penicillin)
Many extra-articular fractures caused by a low velocity bullet do not require antibiotic prophylaxis provided that the fracture can be stabilized, that there is no evidence of gross contamination, and that the wound does not involve the distal tibia, foot or hand.
