Abstract: Introduction: The evidence is building that adding topical antibiotic to standard systemic antibiotic in management of open fractures is lowering the infection rate and complications, however, there is a scarcity of studies in low resource settings. This study aims to evaluate the effect of topical antibiotic on infection rate in open fractures managed in limited-resource settings. Methods: This is a prospective randomised controlled trial comparing topical antibiotic (aqueous gentamycin) and non-topical antibiotic groups. A total of 200 patients with open long bone fractures were admitted, of which 120 patients gave consent and were randomly allocated into the study groups. Eighty patients were excluded from the study .The primary outcome measures were chronic infection rate while the secondary outcome measures included the length of hospital stay, number of surgical procedures and rate of non-union. Results: The mean time of injury to the time of first debridement was 6 days and the delays were observed in all stages due to poor access to surgical care. We recorded a significant reduction of infection rate in the 2nd (p = 0.015) and 6th (p = 0.045) weeks, but non-significant reduction at 6th month (p = 0.3) in the topical group compared to the non-topical group. As compared to the non-topical group, for the topical group we recorded a reduced number of procedures (p = 0.004), reduced length of hospital stay (p = 0.006), the rate of non-unions at 6-month follow-up (p = 0.01). Conclusion: This study shows that the use of local aqueous gentamycin administration as an adjunct to conventional management of open fractures is effective in lowering the infection rates, reducing the number of operations, reducing length of hospital stay and non-union rates.