Because of a low risk of
infection (around 2-3%), prophylactic use of
antibiotics in neurosurgery is a controversial issue. Some neurosurgeons consider that there are strong arguments against the use of antimicrobials (promotion of
antibiotic-resistant strains of bacteria,
superinfection and
adverse drug reactions) and meticulous aseptic techniques could be more usefully than prophylactic
antibiotics. On the other hand, despite of being rare, the consequences of a neurosurgical
infection can be dramatic and may result in a rapid death, caused by
meningitis, cerebritis,
abscess formation or
sepsis. Clinical studies emphasized that the most important factors influencing the choice of
antibiotic prophylaxis in neurosurgery is the patient's immune status, virulence of the pathogens and the type of surgery ("clean contaminated"--procedure that crosses the cranial sinuses, "clean non-implant"--procedure that does not cross the cranial sinuses, CSF shunt surgery,
skull fracture). Prophylaxis has become the standard of care for contaminated and clean-contaminated surgery, also for surgery involving insertion of artificial devices. The
antibiotic (first/second generation of
cephalosporins or
vancomycin in allergic patients) should recover only the cutaneous possibly contaminating flora (S. aureus, S. epidermidis) and should be administrated 30' before the
surgical incision, intravenously in a single dose. Most studies pointed that identification of the risk factors for
infections, correct asepsis and minimal prophylactic
antibiotic regimen, help neurosurgeons to improve patient care and to decrease mortality without selecting resistant bacteria.