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Acute Systemic Antimicrobial Prophylaxis (ASAP) is the standard of care for managing open fractures. There is concern that protocols do not address the modern open fracture bioburden. Online databases were searched to estimate the effect size in reducing the risk of postoperative infections in open fracture management stratified by regimen and fracture classification. 2,031 patients from 17 studies were analyzed. Meta-analysis of Type III open fractures suggested that Flucloxacillin + Benzylpenicillin had a lower infection rate than Cefazolin + Gentamicin; furthermore, the duration of hospitalization was extended by four days with Cefazolin + Gentamicin in Type II/III open fractures. No one antibiotic prophylactic regimen can be recommended over another in the management of open fractures with the current available data. We offer methodological guidelines for future trials that will allow robust evidence for future studies.

Abstract licence: CC BY

IntroductionCommunity-acquired pneumonia (CAP) is a major cause of morbidity and mortality in older adults in Japan. Prolonged hospitalisation accelerates functional decline, promotes the progression of frailty and increases the need for long-term care. An early switch from intravenous to oral antibiotics helps achieve clinical outcomes comparable to those of continued intravenous therapy while shortening hospital stays. For older adults with frailty, avoiding unnecessary hospitalisation may help prevent further deterioration of functional status. Demonstrating non-inferiority of oral antibiotics for clinical cure would help clinicians recommend the use of switch therapy to shorten hospital stay and improve functional outcomes in this high-risk population. This study aimed to evaluate the non-inferiority of lascufloxacin switch therapy to intravenous ampicillin/sulbactam in older adults with frailty and CAP.Methods and analysisThis multicentre randomised open-label trial enrols older adults with mild to moderate CAP and frailty according to the Frailty Screening Index. Participants will be randomised using minimisation with the Age, Dehydration, Respiratory Failure, Orientation Disturbance and Low Blood Pressure score and Frailty Screening Index as allocation factors to receive either lascufloxacin switch therapy or ampicillin/sulbactam intravenous. The primary endpoint is the clinical cure rate at the test of cure. Secondary endpoints include early clinical response, end-of-treatment response, hospital stay, medical costs, clinical stability, 30-day mortality or recurrence and microbiological outcomes. The planned sample size is 80 patients per group.Ethics and disseminationThis study was approved by the Certified Review Board of Nagasaki University, Japan. These results will be disseminated through scientific presentations and publications.Trial registration numberjRCTs071250072 (https://jrct.mhlw.go.jp/en-latest-detail/jRCTs071250072).

Abstract licence: CC BY-NC