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FOI Request

Disclosure ID
FOI/02455
Request Date
May 21, 2018
Subject
Open Fracture Surgery
Description
  1. Does the Trust perform surgery for open fractures?
  2. Does the Trust have a specific guideline/policy regarding antibiotic prophylaxis for patients with open fractures?
  3. If yes, please could this be emailed to me
  4. If no, what is the commonest form of antibiotic propylaxis (and duration) that these patients are given?
Response
  1. The trust performs surgery for open fractures (also called compound fractures ) though most of them go to Preston recently as a Trauma centre
  2. Antibiotic – 1st line
    Flucloxacillin 1g q6h IV
    plus
    Metronidazole 500mg q8h IV
    plus
    Gentamicin (see attached for full gentamicin policy)
    Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.
    5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or 3mg/Kg IV q24h (max 300mg): If ≥70 years or CrCl 1029.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment) Round to nearest 20mg for ease of administration CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
    If patient is obese ie. 20% over ideal body weight – use adjusted body weight
    If renal failure
    Co-amoxiclav IV 1.2g q8h or 625mg q8h PO if discharge
    Continue 24hours after closure of wound
  3. N/A
  4. Compound fracture
Attachment 1
attachment_24.pdf
Attachment 2
Attachment 3
Attachment 4
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Attachment 9