Q. Which of these antibiotic
is least likely to be used in this patient with open fracture operatively
managed (radiograph below )?
1. vancomycin
2. tobramycin
3. gentamicin
4. doxycycline
Answer –
The radiograph shows a femur fracture fixed with
interlocking nail and a radio-opaque chain of beads of certain radio-opaque
material (most probably bone cement or PMMA, poly methyle metha acrylate). As
it is open fracture, the cement might be used with mixed antibiotics for higher
local concentration and delivery of antibiotics.
The antibiotics should be heat stable as the bone cement
maturation is exothermic process and the heat generated might diminish potency
of antibiotics that are not heat stable.
Commonly used antibiotics for this purpose are-
Gentamicin
Tobramycin
Vancomycin
Certain cephalosporins
Daptomycin
Thus doxycycline is
the correct answer.
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