A Gustilo-Anderson type IIIB open tibial fracture from a farm injury is taken up for debridement. The recommended systemic antibiotic cover is:
- A First generation cephalosporin plus an aminoglycoside, with high dose penicillin added for soil contamination ✓
- B First generation cephalosporin alone
- C Fluoroquinolone monotherapy
- D Vancomycin plus metronidazole
Correct answer: A. First generation cephalosporin plus an aminoglycoside, with high dose penicillin added for soil contamination
Explanation
Type III open fractures require gram-positive coverage with a first generation cephalosporin plus gram-negative coverage with an aminoglycoside such as gentamicin. Farm injuries and soil contamination add clostridial risk, so high dose penicillin is added. Cephalosporin alone suffices only for type I injuries, quinolone monotherapy is inadequate against gram-negatives in this setting, and vancomycin is reserved for beta-lactam allergy or proven MRSA colonisation.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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