Topical antibiotics in neurosurgery: a re-evaluation of the Malis technique

We report the effect on the neurosurgical wound infection rate of a modific ation of the 'Malis' technique of antibiotic prophylaxis. Ln this a combina tion of antibiotics is given in the form of both parenteral administration and wound irrigation. A series of 1173 clean neurosurgical operations was c ompared with a historical control of 303 operations. Both treatment and con trol groups were operated on by the same surgeon, using similar surgical te chniques. The control group received parenteral pre- and postoperative anti biotics (flucloxacillin and ampicillin). The treatment group (where the par enteral antibiotic used was cephradine) also received wound irrigation with a solution of gentamicin and flucloxacilin. The infection rate was 0.42% i n the treatment group (five patients), in the control group it was 3.96% (1 2 patients). The difference was highly significant (p = 0.00006). We believ e that the use of wound irrigation with antibiotics should receive further study.