A farmer sustains a Gustilo-Anderson Type II open tibial fracture contaminated with soil. Along with a first generation cephalosporin, which additional antibiotic must be added to the prophylactic regimen?
- A High dose intravenous penicillin ✓
- B Vancomycin
- C Metronidazole alone
- D Fluconazole
Correct answer: A. High dose intravenous penicillin
Explanation
Farmyard and soil contamination carries a high risk of gas gangrene caused by Clostridium perfringens. Standard regimens give a gram positive cover agent such as cefazolin for all open fractures and add an aminoglycoside for Type III wounds, but clostridial cover with high dose crystalline penicillin is specifically added when the wound is contaminated with soil, manure, or water. Metronidazole has anaerobic activity but penicillin remains the conventionally tested answer for clostridial prophylaxis in these injuries.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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