Antibiotics for Preventing Infection in Open Limb Fractures

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on antibiotics for preventing infection in open limb fractures. This review was selected for the TREKK Evidence Repository on fractures.

Key Messages:

week-6-blogshot_fractures_antibiotics

Related TREKK Resources:

Cochrane Summary:

Antibiotics for preventing infection in open limb fractures

Wound and bone infections are common complications following open fractures of the limbs. For more than 20 years in developed countries, the use of antibiotics has been a part of a standard management protocol that also includes washing the wound (irrigation), cleaning up the wound and fracture (surgical debridement), and stabilisation of the fracture, as required. This review, which included data from 1106 participants in eight trials, found that antibiotics are effective in decreasing the incidence of wound infections, as compared with no antibiotics or placebo. No studies reporting bone infection or long-term ill health (morbidity) were identified.

Authors’ Conclusions:

Antibiotics reduce the incidence of early infections in open fractures of the limbs. Further placebo controlled randomised trials are unlikely to be justified in middle and high income countries, except for open fractures of the fingers. Further research is necessary to the determine the avoidable burden of morbidity in countries where antibiotics are not used routinely in the management of open fractures.

Check Out the Full Cochrane Systematic Review Below:

Gosselin, R.A., Roberts, I., Gillespie, W.J. (2004). Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev, 1, CD003764. doi: 10.1002/14651858.CD003764.pub2

The Cochrane Bone, Joint and Muscle Trauma Group also recommends the following systematic reviews related to fractures in children:

Black, K.J., Bevan, C.A., Murphy, N.G., Howard, J.J. (2013). Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev, 12, CD009587. doi: 10.1002/14651858.CD009587.pub2

Yeung, D.E., Jia, X., Miller, C.A., Barker, S.L. (2016). Interventions for treating ankle fractures in children. Cochrane Database Syst Rev, 4, CD010836. doi: 10.1002/14651858.CD010836.pub2

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.

Evidence-Based Treatments for Acute Otitis Media (Middle Ear Infection)

April 27 – This week’s blog post is also available from TREKK (Translating Emergency Knowledge for Kids)

AOM blogshot photo

Background:

Middle ear infections (acute otitis media) are one of the most common infections of childhood (1,2). Despite being common, they are often hard for doctors to diagnose since they look very similar to a cold or flu. Symptoms include ear pain, fever, irritability, trouble sleeping, cough and a runny nose (2). To diagnose an ear infection, a doctor needs to look at a child’s ear drum with a tool known as an otoscope. However, ear wax can often block a doctor’s view, and changes in the ear drum can be hard to see (1).

Despite what many people think, not all children need antibiotics to treat their ear infection. Over use of antibiotics can lead to side effects and even antibiotic resistance! The Canadian Pediatric Society recommends using antibiotics to treat a confirmed ear infection in all children under six months or with severe symptoms (2). For children older than six months with minor symptoms a ‘watchful waiting’ approach is preferred. In ‘watchful waiting’ a child is given pain medicine, and only given antibiotics if pain persists after 24-48 hours. However, some parents are worried about withholding antibiotics when their child is in pain or discomfort.

blogshot ear photo

What does the evidence say?

The current best evidence supports the ‘watchful waiting’ approach. A Cochrane systematic review studied antibiotic use to treat ear infections in 13 trials which studied nearly 3 401 children with ear infections. The study confirmed these key findings:

  • About six out of ten children get better within 24 hours without the use of antibiotics
  • Antibiotics do not reduce pain at 24 hours any more than a sugar pill
  • Children who were immediately given antibiotics had no difference in pain compared to those who waited 24-48 hours to start antibiotics.
  • Antibiotics reduce the rate of some complications, such as ear drum rupture and reoccurrence
  • Compared to a sugar pill, children taking antibiotics for an ear infection were about twice as likely to have vomiting, diarrhea, and rash.

So what can you do while ‘watchfully waiting’?

  • Give your child pain medicine like ibuprofen (Advil) or acetaminophen (Tylenol). Make sure the medicine is appropriate for their age and size.
  • Putting a warm compress on the ear
  • Asking your doctor for pain reducing ear drops
  • Giving your child lots of rest
  • Going back to the doctor if your child has not improved within 48 hours or worsens

In Summary:

If your child is experiencing symptoms of an ear infection (ear pain, fever, irritability, trouble sleeping, cough and a runny nose) you should see your doctor. Depending on how severe of an infection, and how old your child is, they may give you antibiotics immediately, or ask you to wait 1-2 days.

 

More information about ear infections can be found online at https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=hw184385&#hw184387

TREKK Resources:

References:

  1. Oleszczuk, M., Fernandes, R. M., Thomson, D., & Shaikh, N. (2012). The Cochrane Library and acute otitis media in children: an overview of reviews. EvidenceBased Child Health: A Cochrane Review Journal7(2), 393-402.
  2. Le Saux, N., & Robinson, J.L. (2016). Management of acute otitis media in children six months of age and older. Canadian Pediatric Society. Paediatrics & Child Health 21(1), 39-44
  3. Goldman, R. D., & Hazardous Substances Committee. (2011). Treating cough and cold: guidance for caregivers of children and youth. Paediatrics & Child Health16(9), 564.