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Antibiotic prophylaxis for pretibial haematomas in the elderly population
  1. Stewart Teece, Clinical Research Fellow,
  2. Ian Crawford, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether prophylactic antibiotics reduce infections and other complications in elderly patients with pretibial haematomas. Altogether 65 papers were found using the reported search, of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.

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    Report by Stewart Teece,Clinical Research FellowChecked by Ian Crawford, Clinical Research Fellow

    Clinical scenario

    A 95 year old woman attends the emergency department having slipped against her zimmer frame, hitting her right shin. Examination shows a 10 cm haematoma with no break to the skin. Given the site and size of the haematoma you feel there is a risk of infection developing in the haematoma before it resolves. You therefore arrange clinic follow up and give her prophylactic flucloxacillin. On discussing the case the next day it becomes apparent that a number of colleagues would not have bothered with the antibiotics. You decide to check the literature to see who is right.

    Three part question

    In [elderly patients with a large pretibial haematoma] does [the prophylactic use of antibiotics] give [a reduction in infective complications]?

    Search strategy

    Medline 1966-03/04 and CINAHL 1980-03/04 using the OVID interface. Medline: [{exp Hematoma OR haematoma.af OR hematoma.af OR exp CONTUSIONS OR contusion.af} AND {exp TIBIA OR tibia$.af OR shin.af OR exp LEG OR leg.af} AND {exp Anti-Bacterial Agents OR antibiotic.af. OR anti-biotic.af. OR infection.af}] LIMIT to English language. CINAHL: [{exp Hematoma OR haematoma.af OR hematoma.af OR exp CONTUSIONS OR contusion.af} AND {exp TIBIA OR tibia$.af OR shin.af OR exp LEG OR leg.af} AND {exp Antibiotics OR antibiotic.af. OR anti-biotic.af. OR infection.af}] LIMIT to English language.

    Search outcome

    Altogether 65 papers found on Medline, 30 on CINAHL none of which answered the three part question.

    Comment

    There are no trials of any kind looking at the use of prophylactic antibiotics on the incidence of infections or complications in patients with pretibial haematomas.

    CLINICAL BOTTOM LINE

    There is no evidence to confirm/refute the use of antibiotics in pretibial haematoma, local guidelines should be followed.

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