Four cases of clostridial myonecrosis that developed in open fractures were treated with surgical debridement and with intravenous cephalosporins as antibiotic prophylaxis. All patients recovered following amputation of the involved extremity, and treatment with high-dose penicillin in three cases, and erythromycin plus high-dose cephalothin in the fourth. This complication was not seen in patients with similar injuries that were managed surgically but used other antibiotics, usually penicillin, as prophylaxis. In vitro susceptibility tests of clostridia to cephalothin were performed; the results demonstrated that nearly 50% of clostridia tested were resistant to cephalothin.
(JAMA 239:847-849, 1978)