A farm worker sustains a Gustilo-Anderson Type III open tibial fracture with gross soil contamination. Along with cephalosporin and aminoglycoside coverage, which additional agent is specifically indicated?
- A Oral metronidazole monotherapy
- B High-dose intravenous penicillin ✓
- C Intravenous vancomycin as routine first line
- D No additional agent if debridement was performed within 6 hours
Correct answer: B. High-dose intravenous penicillin
Explanation
Type III open fractures carry a real risk of clostridial myonecrosis from soil contamination. Standard practice is a first-generation cephalosporin plus an aminoglycoside, with high-dose penicillin added specifically to cover Clostridium species in grade III injuries and farmyard contamination. Vancomycin is reserved for documented methicillin resistance or severe beta-lactam allergy, and prompt debridement does not remove the need for anaerobic cover.
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.