A Cochrane review [Abstract] 1 included 23 studies with a total of 8 447 subjects; people with a hip fracture undergoing surgery for internal fixation or prosthetic replacement, or with any closed long bone fracture undergoing internal fixation. Single dose antibiotic prophylaxis significantly reduced deep surgical site infection (RR 0.40, 95% CI 0.24 to 0.67), superficial surgical site infections (RR 0.69, 95% CI 0.50 to 0.95), urinary infections (RR 0.63, 95% CI 0.53 to 0.76), and respiratory tract infections (RR 0.46, 95% CI 0.33 to 0.65) compared with a placebo or no treatment. Multiple dose prophylaxis had an effect of similar size on deep surgical site infection (RR 0.35, 95% CI 0.19 to 0.62), but significant effects on urinary and respiratory infections were not confirmed. Economic modelling using data from one large trial indicated that single dose prophylaxis with ceftriaxone is a cost-effective intervention. Data for the incidence of adverse effects were very limited; they appeared to be more common in those receiving antibiotics, compared with placebo or no prophylaxis; RR for gastro-intestinal symptoms 1.82, 95% CI 0.91 to 3.66; RR for skin reactions 1.91, 95% CI 0.61 to 6.01; and RR for infusion site thrombophlebitis 2.32, 95% CI 0.61 to 8.80.
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