Results of r and omized controlled trials performed to date provide evidence that antibiotic prophylaxis reduces subsequent infection and that courses as short as one day are as effective as courses of three to five days , although the evidence warrants only low to moderate confidence .
BACKGROUND The purpose of the present study was to perform a systematic review and meta- analysis of the use of alternative antibiotic regimens-including ( A ) antibiotic prophylaxis versus no prophylaxis , ( B ) longer versus shorter duration of antibiotic prophylaxis , and ( C ) alternative drugs-for  patients with open fracture of the extremities .
Fluid lavage of open wounds (FLOW): a multicenter, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures.
BACKGROUND Open fractures are an important source of morbidity and are associated with delayed union , nonunion , and infection . Preventing infection through meticulous irrigation and debridement is an important goal in management , and different lavage fluids and irrigation techniques ( e.g. , high- or low-pressure lavage ) have been described for this purpose . However , there are a limited number of r and omized trials comparing irrigating solutions or irrigating technique . We compared the use of castile soap versus normal saline and high- versus low-pressure pulsatile lavage on the rates of reoperations and complications in patients with open fracture wounds . METHODS We conducted a multicenter , blinded , r and omized 2 × 2 factorial pilot trial of 111 patients in whom an open fracture wound was treated with either castile soap solution or normal saline and either high- or low-pressure pulsatile lavage . The primary composite outcome of reoperation , measured at 12 months after initial operative procedure , included infection , wound healing problems , and nonunion . Planned reoperations were not included . Secondary outcomes included all infection , all wound healing problems , and nonunion as well as functional outcomes scores ( EuroQol-5 dimensions and short form-12 ) . RESULTS Eighty-nine patients completed the 1-year follow-up . Among all patients , 13 ( 23 % ) in the castile soap group and 13 ( 24 % ) in the saline group had a primary outcome event ( hazard ratio , 0.91 , 95 % confidence interval : 0.42 - 2.00 , p = 0.52 ) . Sixteen patients ( 28 % ) in the high-pressure group and 10 patients ( 19 % ) in the low-pressure group had a primary outcome event ( hazard ratio 0.55 , 95 % confidence interval : 0.24 - 1.27 , p = 0.17 ) . Functional outcome scores showed no significant differences at any time point between groups . CONCLUSION The fluid lavage of open wounds pilot r and omized controlled trial demonstrated the possibility that the use of low pressure may decrease the reoperation rate for infection , wound healing problems , or nonunion . We have demonstrated the desirability and feasibility of a definitive trial examining the effects of alternative irrigation approaches
Results of r and omized controlled trials performed to date provide evidence that antibiotic prophylaxis reduces subsequent infection and that courses as short as one day are as effective as courses of three to five days , although the evidence warrants only low to moderate confidence .
BACKGROUND The purpose of the present study was to perform a systematic review and meta- analysis of the use of alternative antibiotic regimens-including ( A ) antibiotic prophylaxis versus no prophylaxis , ( B ) longer versus shorter duration of antibiotic prophylaxis , and ( C ) alternative drugs-for  patients with open fracture of the extremities .