Depressed fracture of skull

• Cefotaxime: 3rd-gen cephalosporin, excellent for Gram-negatives and Streptococcus spp., but weak against Staphylococcus aureus, and little anaerobic coverage.
• Flagyl (metronidazole): good anaerobic coverage.
• Unictam (ampicillin/sulbactam): covers anaerobes, some Gram-negatives, and MSSA, but less potent than cefotaxime for serious Gram-negative infections.

Is Unictam needed?

• If you’re already using cefotaxime + Flagyl, you have:
  • Strong Gram-negative and anaerobic coverage.
  • Weak anti-staphylococcal coverage — this is the gap.
• Unictam adds MSSA coverage, but it’s redundant for anaerobes (overlaps with Flagyl) and inferior to cefotaxime for serious Gram-negatives like Enterobacteriaceae.

Conclusion:

• If the main concern is MSSA or MRSA (e.g., skin flora due to open fracture), a better option than Unictam would be:
  • Add vancomycin (if MRSA is suspected) to cefotaxime + Flagyl.
• Unictam is not essential here and may add redundancy without significantly improving coverage.