Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime.
Cefuroxime is a second-generation cephalosporin with in vitro activity against the organisms that are commonly associated with neurosurgical wound infections. Other properties of cefuroxime are an elimination half-life of 1.3 hours, which yields prolonged serum concentrations, and its ability to penetrate the blood-brain barrier in proportion to the degree of inflammation. A prospective, multicenter, open-label study was conducted to evaluate the efficacy and safety of cefuroxime for antibiotic prophylaxis in patients undergoing clean neurosurgery. Cefuroxime 1.5 g was given intravenously 25 to 60 minutes before surgery; for procedures lasting more than 3 hours, cefuroxime 750 mg was given intravenously 8 hours after the initial dose. Patients were examined before surgery, daily during hospitalization, and at 8 weeks after surgery. A total of 956 adults were enrolled in the study. The most common procedures in study patients were laminectomy (41.8% of patients) or craniotomy (24.3%), and the mean duration of surgery was 3.2 hours. Infection occurred in 2 (0.3%) of 592 assessable patients by the time of discharge and in 1 additional patient by the 8-week follow-up evaluation for a total of 3 (0.5%) of 560 assessable patients. Drug-related adverse events occurred in 5 (0.5%) of 956 patients. These results indicate that antibiotic prophylaxis with cefuroxime is associated with a low incidence of postoperative wound infection and is well tolerated in patients undergoing clean neurosurgery.
Holloway
K L
KL
Virginia Commonwealth University, Richmond, Virginia, USA.
Smith
K W
KW
Wilberger
J E
JE
Jemsek
J G
JG
Giguere
G C
GC
Collins
J J
JJ
D000328:Adult; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014481:United States
D002511:Cephalosporins; D002444:Cefuroxime