Romanian Neurosurgery (Sep 2010)
Prophylactic antibiotherapy in Neurosurgery
Abstract
Prophylactic use of antibiotics in neurosurgery which mean to use an antibiotic before infection start, to reduce the incidence of postoperative wound infections, still is a controversial issue for strong arguments against the use of antimicrobials: promotion of antibiotic-resistant strains of bacteria, superinfection and adverse drug reactions. Prophylaxis has become the standard of care for contaminated, clean-contaminated surgery, insertion of artificial devices. The antibiotic: first/second generation of cephalosporins or vancomicin in allergic patients should recover only the cutaneous posibily contaminating flora (S. aureus, S. epidermidis) and shoud be administrated 30’ before the surgical incision, intravenously in a single dose. Most studies pointed that identification of the risk factors for infections, correct asepsia and minimal prophylactic antibiotic regimen adopted to each case, help neurosurgeons to improve patient care and decrease mortality without selecting resistant germens. In conclusion in neurosurgical operations it’s mandatory to assure: - an optimum protection at operation by a careful evaluation of asepsia - prophylactic antibiotics should be used for 24 hours, after patient consent, using a minimal schema, adapted to each operation risk factors and the patient status - prophylactic use of antibiotics is different of antibiotherapy; wide spectrum antibiotics of high dosis and for long term used as standard to cover technical errors should to be avoided.
