Background: The incidence of a fracture-related infection (FRI) can reach 30% of open tibia fractures (OTF). The use of antibiotic-coated implants is one of the newest strategies to reduce the risk of infection in orthopedic surgery. Aim: The purpose of this study was to evaluate the efficacy of antibiotic-coated intramedullary locking nail in the open tibia fractures. Materials and Methods: This prospective observational study was carried out in the Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pardesh, India from November 2015 to December 2016. Total 70 patients were treated with gentamicin coated tibia interlocking nail. Patients with Open fractures gustillo anderson type 1, 2, 3A fracture were included in this study. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Result: All 70 patients 44.28% of the patients between 30-40 years of age, 28.57% of the patients between 40-50 years of age and 20% above 50 years and 7.14% of patients below 30 years. Males were 72.86% against females 27.14%. The most common cause of injury was found to be due to road traffic accident and accounted for 55(78.57%) of cases. Fibula fracture was associated with 65(92.86%) of patients. Time taken in wound healing in majority of patients was less than 6 weeks 35 (50%), 6-8 weeks 22(31.43%), 8-10weeks 7(10%) and those were not healed 6(8.57%). Majority of patents 40(57.14%) had RUST score 9 at six months of duration, 15(21.43%) of patients had RUST score 11 and 6(8.57%) patients RUSH score was 6 at six months. 6 cases got infected in this study and in 4 cases there was non union. Average duration of hospital stay was 16.5 days. Out of 70 patients, 8(11.14%) patients had excellent outcome, 15(21.43%) had good and 41(58.57%) fair and only 6(8.57%) patients had poor outcome. Average time of wound healing in our study was 4.25 weeks. Out of 70 patients, fracture union was achieved in 68 (97.14%) patients and two patient (2.86%) patient undergone non unions. This study comprised of 70 patients, out of them 41 patients (58.57%) had grade-I, 23 patients (32.86%) had grade-II and 6 patients (8.57%) had grade-III compounding. Conclusion: Implant related infection pose an important challenge in the surgical treatment of tibia shaft fracture. Local administration of antibiotics might minimize the risk of infection