• Joshua Nyaribari Ondari, Moses Muia Masika, Richard Bwana Ombachi, and John Ernest Ating'a.
• Department of Orthopaedic Surgery, University of Nairobi, Kenya. Electronic address: jondari59@gmail.com.
• Injury. 2016 Oct 1; 47 (10): 2288-2293.

ObjectiveTo determine the difference in infection rate between 24h versus five days of prophylactic antibiotic use in management of Gustilo II open tibia fractures.DesignUnblinded randomized control trial.SettingAccident and Emergency, orthopedic wards and outpatient clinics at Kenyatta National Hospital (KNH).PatientsThe study involved patients aged 18-80 years admitted through accident and emergency department with Gustilo II traumatic open tibia fractures.InterventionPatients were randomized into either 24hour or five day group and antibiotics started for 24hours or five days after surgical debridement. The wounds were exposed and scored using ASEPSIS wound scoring system for infection after 48h, 5days and at 14days.Outcome MeasuresThe main outcomes of interest were presence of infection at days 2, 5 and 14 and effect of duration to antibiotic administration on infection rate.ResultsThere was no significant difference in infection rates between 24-hour and 5-day groups with infection rates of 23% (9/40) vs. 19% (7/37) respectively (p=0.699). The infection rate was significantly associated with time lapsed before administration of antibiotics (p=0.004).ConclusionIn the use of prophylactic antibiotics for the management of Gustilo II traumatic open tibia fractures, there is no difference in infection rate between 24hours and five days regimen but time to antibiotic administration correlates with infection rate. Antibiotic use for 24hours only has proven adequate prophylaxis against infection. This is underlined in our study which we hope shall inform practice in our setting. A larger, more appropriately controlled study would be useful.Copyright © 2016 Elsevier Ltd. All rights reserved.

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