ABSTRACT
BACKGROUND: The optimal antibiotic regimen is still controversial in open fractures. The purpose of this study was to evaluate the efficacy of two different antibiotic regimens in management of type III-A open fractures. METHODS: From January 2001 to January 2008, patients with type IIIA open fractures admitted in Shahid Beheshti Hospital Affiliated to Babol University of Medical Sciences were enrolled. Patients randomly received cefazolin plus gentamicin (group I) or cefazolin plus ciprofloxacin (group II). Both regimens were administered for 3 days. All patients were followed for 3 months. The efficacy of both regimens was compared. RESULTS: One hundred-forty eight and 153 patients were treated in group I and II, respectively. The mean age of the patients treated in group I was 36.96±14.4 and in group II was 36.93±13.51 years. The rate of deep infection in group I was 5.4% and in group II was 6.5%. The efficacy of regimen I was 94.6% and regimen II was 93.5%. CONCLUSION: Cefazolin plus gentamicin, or cefazolin plus ciprofloxacin both can be successfully used for prevention of infection in type IIIA open fractures.
ABSTRACT
OBJECTIVES: To compare the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks with streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis. METHODS: In each arm of the study, 82 patients older than 10 years randomly received 5 mg/kg gentamicin once daily for 5 days plus 100 mg of doxycycline twice daily for 8 weeks or 1 g of streptomycin intramuscularly for 2 weeks plus the same dose of doxycycline for 45 days. Therapeutic failure and relapse in these two treatment groups were compared. This study was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: IRCT138708191441N1. RESULTS: The clinical manifestations in these two groups were similar. Therapeutic failure was seen in two (2.4%) patients in the gentamicin/doxycycline group and in four (4.9%) patients in the streptomycin/doxycycline group [relative risk (RR) = 0.5, 95% confidence interval (CI) 0.09-2.66, P = 0.68]. Relapse was seen in two (2.4%) cases in the gentamicin/doxycycline group and in five (6.1%) cases in the streptomycin/doxycycline group (RR = 0.4, 95% CI 0.08-2, P = 0.44). The efficacy with the gentamicin/doxycycline regimen was 95.12% and that with the streptomycin/doxycycline regimen was 89% (RR = 1.07, 95% CI 0.98-1.17, P = 0.25). Cox regression analyses showed no differences among the two treatment groups for patients who had relapse or therapeutic failure and those who had not regarding baseline covariates such as sex, duration of disease before diagnosis, positive blood culture and focal disease. CONCLUSIONS: The results show that the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks is not superior to that of streptomycin for 2 weeks plus doxycycline for 45 days.
