A farm labourer sustains a Gustilo-Anderson Type IIIB open tibial fracture with heavy soil contamination. After immediate debridement, the MOST appropriate intravenous antibiotic regimen is:

• A Cefazolin alone
• B Vancomycin monotherapy
• C Cefazolin plus an aminoglycoside such as gentamicin ✓
• D Metronidazole monotherapy

Explanation

First generation cephalosporin covers gram positive organisms in all open fractures; Type III wounds require additional gram negative coverage with an aminoglycoside. Farm injuries or soil contamination warrant adding penicillin or metronidazole for clostridial cover, but metronidazole alone is inadequate. Vancomycin monotherapy is reserved for beta lactam allergy or MRSA colonisation, not routine prophylaxis. Antibiotics should start as soon as possible after injury.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.