CEFTIZOXIME VERSUS VANCOMYCIN AND GENTAMICIN IN NEUROSURGICAL PROPHYLAXIS - A RANDOMIZED, PROSPECTIVE, BLINDED CLINICAL-STUDY

IN A PROSPECTIVE, randomized, blinded study, 826 patients undergoing c lean neurosurgical procedures received single intravenous doses of cef tizoxime (2 g) (n = 422) or a combination of vancomycin (1 g) and gent amicin (80 mg) (n = 404) 1 hour before an incision was made. Patients with infected or contaminated wounds and those receiving shunts or oth er implants were excluded. Primary wound infections occurred within 30 days in five patients in each group and were most common after spinal surgery and procedures through previous incisions. Secondary infectio ns (pneumonias, urinary tract infections, and intravenous line-related bacteremia) occurred in 24 patients in the ceftizoxime group and 25 i n the vancomycin/gentamicin group. The infection rates after transsphe noidal procedures (n = 129) were remarkably low in both groups. Ceftiz oxime caused no adverse drug reactions, but six patients in the vancom ycin/gentamicin group had clinically significant infusion-related hypo tension or flushing. Placement of a temporary external drain, use of a n operating microscope, preoperative steroids, and diabetes were not a ssociated with increased infection rates. Analysis of routinely encoun tered ventricular cerebrospinal fluid and simultaneously obtained peri pheral blood showed low but detectable levels of all three antibiotics within 2 hours; only ceftizoxime, however, achieved cerebrospinal flu id levels sufficient to inhibit the staphylococcus and Gram-negative b acilli most often associated with postneurosurgical infections. We con clude that ceftizoxime is as effective as vancomycin and gentamicin in neurosurgical prophylaxis but is less toxic and penetrates cerebrospi nal fluid better.