A farmer sustains a Gustilo-Anderson Type IIIB open tibial fracture in a barnyard accident with heavy soil contamination. Along with urgent debridement, the MOST appropriate antibiotic regimen is:
- A Intravenous cefazolin alone
- B Intravenous cefazolin plus gentamicin, with the addition of high-dose penicillin for clostridial cover ✓
- C Oral ciprofloxacin monotherapy
- D Intravenous vancomycin plus metronidazole only
Correct answer: B. Intravenous cefazolin plus gentamicin, with the addition of high-dose penicillin for clostridial cover
Explanation
Type III open fractures require a first-generation cephalosporin combined with an aminoglycoside for gram-negative cover. Farm or sewage contamination adds the risk of Clostridium species, so high-dose penicillin is added for anaerobic clostridial cover. Cefazolin alone suffices only for Gustilo type I and II injuries, and fluoroquinolone monotherapy is inadequate for severe contaminated wounds. Tetanus prophylaxis is given alongside these agents.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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