Randomized Trial to Assess PO Versus IV Antibiotics

Inclusion criteria

• Patients with any fractures of any bone at or proximal to and including the tarsal/metatarsal joint (Lisfranc) or proximal to the carpal joints (includes distal radius fractures), excluding the spine, treated with any type of internal fixation, or
• Patients undergoing fusion of any bone at or proximal to and including the subtalar joint or radial carpal joint, (excluding the spine) that develop a post op wound infection at any time.
• Patients diagnosed with a wound infection of the study injury, defined as patients with at least one of the following:

• Deep culture positive after operative debridement.
• Cultures positive in thio only after operative debridement.
• Negative culture after operative debridement if wound infection meets the Center for Disease control and Prevention (CDC) criteria.
• Patients who are English or Spanish competent.
• Patients aged 18 - 84.
• Patients with bacteria susceptible to both PO and IV antibiotics.
• Patients able to be treated for their infection at the METRC facility for at least 12 months following definitive surgical procedure
• Patients may have multiple eligible study-eligible injuries.
• Patients may have temporary external fixation prior to definitive fixation.
• Patients may have received antibiotics prior to operative wound debridement.
• Patient is able to obtain study medication(s).
• Patient may be pregnant at the time of screening.

Exclusion criteria

• Patients who have high risk of amputation of the study limb (based on opinion of the initial managing physician).
• Patients undergoing treatment with any other investigational therapy within the month preceding implantation or planned within the 12 months following implantation.
• Patients with history of chronic infection at the site of study injury, defined as:

patients with chronic osteomyelitis identified by radiographic erosion or sequestrum; or patients with more than one instance of surgical treatment of infection and approximately 6 week course of antibiotics.

• Patients with pathological fractures; a known history of Paget's disease.
• Patients for whom the definitive treatment of the study injury was an external fixator.
• Patients who are currently on Selective Serotonin Reuptake Inhibitor (SSRI) medication (e.g. Zoloft, Prozac, Celexa), and bacteria is MRSA
• Patients with cultures positive in thio only.
• 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. .
• Patients or designated proxy who are unwilling to provide consent.
• Patients with a history of IV drug use who in the investigator's opinion are unsuitable candidates for IV therapy.
• 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.
• Patients with traumatic brain injury or who are intellectually challenged and who lack adequate family support to ensure adherence to the protocol.
• Patients unable to swallow oral medications or without adequately functioning GI tract.
• 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).