PROPHYLACTIC AND THERAPEUTIC APPLICATION OF ANTIBIOTICS IN TRAUMATOLOGY

Antibiotic treatment in traumatology (either for prophylactic or thera peutic purposes) can reduce the local bacterial contamination and can therefore improve the balance in favor of the host defence capacity. A bove all, its value has to be measured depending on the local bacteria l colonization in the individual case and to what extent this is the e ssential pathogenetic factor for development of the infection or for r esistance to infection. In situations where local host damage (either traumatic or iatrogenically/surgically induced) is the predominant cof actor for the development or persistence of infection, the antibiotic or other pharmacological reduction of the bacterial colonization is of secondary or no importance at all. In view of this, the indications f or routine antibiotic prophylaxis or therapy, which so far have been a ccepted as valid, should be re-considered. On the one hand, excellent hygienic conditions have increasingly reduced the relative importance of bacterial contamination in aseptic procedures. On the other hand, t he surgical-technical evolution in the last 5 years (such as biologica l osteosynthesis, unreamed intramedullary nailing, stepwise definite s tabilization in complex fractures, initial open wound treatment and ve ry early plastic reconstruction in open fractures, as well as radical necrectomy in chronic infection of bones and soft tissues) could creat e a significant improvement in the conditions concerning prevention an d treatment of infection. Therefore, the relative importance of adjuva nt antibiotic treatment is considerably less. Based on previous studie s, the publications of the past 3 years focusing on this aspect are ex amined critically. Finally, detailed recommendations are defined and a dvice given for well-aimed, controlled continuation studies.