A Prospective Randomized Trial to Assess PO Versus IV Antibiotics for Wound Infection of Extremity Fractures (POvIV)

Inclusion Criteria:

1. Patients with long bone fractures (defined as femurs, tibias, and fibulas of the legs, and the humeri, radii, and ulnas of the arms) treated with a plate that will be retained until union.
2. Patients diagnosed with a wound infection of the study injury, defined as deep culture positive after operative debridement, within six weeks of definitive fixation.
3. Patients who are English or Spanish competent.
4. Patients aged 18 - 84.
5. Patients with bacteria susceptible to both PO and IV antibiotics.
6. Patients able to be treated for their infection at the METRC facility for at least 12 months following definitive surgical procedure
7. Patients may have multiple eligible study-eligible injuries.
8. Patients may have a segmental defect of fracture up to 1 cm.
9. Patients may have temporary external fixation prior to definitive fixation.
10. Patients may have received antibiotics prior to open wound debridement.
11. Patient is able to obtain study medication(s).
12. Patient may be pregnant at the time of screening.

Exclusion Criteria:

1. Patients who are skeletally immature (defined as less than 18 years of age or no radiographic evidence of epiphyseal closure).
2. Patients who have high risk of amputation of the study limb (based on opinion of the initial managing physician).
3. Patients undergoing treatment with any other investigational therapy within the month preceding implantation or planned within the 12 months following implantation.
4. Patients with prior history of infection at the site of study injury.
5. Patients with segmental defects greater than 1 cm in length at the site of study injury.
6. Patients with pathological fractures; a known history of Paget's disease.
7. Patients for whom the definitive treatment of the study injury was an external fixator.
8. Patients who are currently on Selective Serotonin Reuptake Inhibitor (SSRI) medication (e.g. Zoloft, Prozac, Celexa), except those with gram negative bacteria.
9. Patients whose study injury was definitively closed with cement containing antibiotics. (Beads may be placed at initial debridement but must be removed prior to definitive wound or flap closure).
10. Patients with cultures positive in thio only.
11. Patients who are incarcerated or who have unstable housing situations due to concerns regarding ability to receive home care, adherence phone calls, and maintain follow up.
12. Patients or designated proxy who are unwilling to provide consent.
13. Patients with a history of IV drug use who in the investigator's opinion are unsuitable candidates for IV therapy.
14. Patients likely to have severe problems maintaining follow-up, including patients diagnosed with a severe psychiatric conditions, patients who live too far outside the hospital's catchment area.
15. Patients with traumatic brain injury or who are intellectually challenged and who lack adequate family support to ensure adherence to the protocol.
16. Patients unable to swallow oral medications or without adequately functioning GI tract.
17. Patients who, based upon the clinical judgment of the treating clinician, are NOT equally suited for treatment with either oral or intravenous antibiotics (i.e., those for whom there is a clinical treatment preference).