Once daily, high dose versus divided, low dose gentamicin for open fractures

A prospective, randomized study was performed on 75 Gustilo Grades II and I II open fractures to determine the efficacy of once daily, high dose aminog lycoside therapy, compared with more conventional dosing, in reducing the i nfection rate when used in conjunction with an aggressive operative treatme nt protocol. All patients enrolled in the study were treated with immediate irrigation, debridement, operative stabilization of the fracture, and 1 g of cefazolin every 8 hours. At the time of admission patients were randomiz ed to two groups. Patients in Group I received gentamicin 5 mg/kg divided i nto twice daily doses, and patients in Group II received gentamicin 6 mg/kg given once daily. All patients were monitored for renal toxicity and obser ved for radiographic and clinical signs of infection until fracture union. The results of the study revealed no statistically significant difference b etween once daily, high dose versus divided, low dose gentamicin in infecti on rates. Thus, daily dosing of gentamicin was found to be safe, effective, and cost efficient in the treatment of open fractures when combined with a cephalosporin and aggressive operative debridement and stabilization.