In the military, pre-hospital systemic antibiotic prophylaxis (SAP) is used in penetrating injuries or open fractures to prevent infections but is not practiced in civil emergency medical service (EMS). We therefore performed a literature survey of the Pubmed database and assessed studies evaluating the correlation of early, on-scene antibiotics and the infection rates in patients suffering from penetrating injuries or open fractures. Our survey revealed that i.) in case of open fractures there is evidence for pre-hospital SAP reducing the infection rates which not also holds true for the military, but also for the civil EMS; ii.) a time frame from incident to SAP of less than 60 minutes was most important for the effectiveness of SAP; iii.) it is likely that the benefits of prehospital SAP for open fractures might apply to many types of penetrating injuries; iv.) the usage of pre-hospital antibiotics in the civil setting is considered as safe and relatively cheap and can easily be provided by professional health care takers. In conclusion, the pre-hospital antibiotic prophylaxis in open fractures and penetrating injuries might be easily implemented in the civil EMS settings. Future studies with bigger cohorts, however, are needed to further support these findings.
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