[Prophylactic and therapeutic use of antibiotics in trauma surgery].

Antibiotic treatment in traumatology (either for prophylactic or therapeutic purposes) can reduce the local bacterial contamination and can therefore improve the balance in favor of the host defence capacity. Above all, its value has to be measured depending on the local bacterial colonization in the individual case and to what extent this is the essential pathogenetic factor for development of the infection or for resistance to infection. In situations where local host damage (either traumatic or iatrogenically/surgically induced) is the predominant cofactor for the development or persistence of infection, the antibiotic or other pharmacological reduction of the bacterial colonization is of secondary or no importance at all. In view of this, the indications for routine antibiotic prophylaxis or therapy, which so far have been accepted as valid, should be reconsidered. On the one hand, excellent hygienic conditions have increasingly reduced the relative importance of bacterial contamination in aseptic procedures. On the other hand, the surgical-technical evolution in the last 5 years (such as biological osteosynthesis, unreamed intramedullary nailing, stepwise definite stabilization in complex fractures, initial open wound treatment and very early plastic reconstruction in open fractures, as well as radical necrectomy in chronic infection of bones and soft tissues) could create a significant improvement in the conditions concerning prevention and treatment of infection. Therefore, the relative importance of adjuvant antibiotic treatment is considerably less. Based on previous studies, the publications of the past 3 years focusing on this aspect are examined critically. Finally, detailed recommendations are defined and advice given for well-aimed, controlled continuation studies.