WEDNESDAY, April 22, 2026 (HealthDay News) -- The combination of intrawound tobramycin and vancomycin powder is no better than vancomycin powder alone for reducing deep surgical site infection in patients with periarticular tibial fractures, according to a study published online April 15 in the Journal of the American Medical Association.
Robert V. O'Toole, M.D., from the University of Maryland School of Medicine in Baltimore, and colleagues from the Major Extremity Trauma Research Consortium compared whether the combination of tobramycin (1.2 g) plus vancomycin (1.0 g) versus vancomycin (1.0 g) alone delivered as intrawound powder at the time of definitive fixation reduces deep surgical site infections within 182 days. The analysis included 1,528 adults who were operatively treated for a periarticular tibial fracture (either tibial plateau or pilon) and met criteria for elevated infection risk.
The researchers found that deep surgical site infections occurred in 51 of 753 participants (182-day probability, 7.4 percent) in the tobramycin plus vancomycin group and 47 of 775 participants (182-day probability, 6.6 percent) in the vancomycin-alone group (hazard ratio, 1.11; posterior probability of superiority, 29.7 percent). No secondary outcome met the threshold required for superiority.
"The findings should change surgeons' practice to avoid the use of intrawound tobramycin powder in this population, as there is no evidence that it prevents infections and might be harmful in open fracture patients," coauthor Nathan O'Hara, Ph.D., also from the University of Maryland, said in a statement.
Several authors disclosed ties to the biotechnology industry.