The comparative efficacy of intravenous cefotaxime and trimethoprim/sulfamethoxazole in preventing infection after neurosurgery: a prospective, randomized study

The objective of the investigation was to determine the comparative efficac y of cefotaxime versus trimethoprimsulfamethoxazole in the prophylaxis of p atients undergoing neurosurgical procedures. In this prospective randomized open study, 780 adult patients undergoing elective craniotomy, shunt surge ry or stereotactic surgery were randomized to receive preoperative cefotaxi me (1 g) or trimethoprim-sulfamethoxazole (160 mg trimethoprim, 800 mg sulf amethoxazole) as prophylaxis: 613 patients were available for analysis, of whom 315 received cefotaxime and 298 received trimethoprimsulfamethoxazole. Forty-two patients (6.9%) experienced 49 postoperative infections, with no significant difference between treatment groups. The most common infection s unrelated to neurosurgery were urinary tract infections (17 cases) and pn eumonia (seven cases). Fifteen neurosurgical infections occurred, comprisin g 11 wound infections, two shunt infections and two cerebral abscesses. Neu rosurgical infection rates were similar in the cefotaxime group (2.5%) and the trimethoprim-sulfamethoxazole group (2.3%). We concluded cefotaxime and trimethoprim-sulfamethoxazole administered as single dose prior to neurosu rgery are equally effective in controlling neurosurgical infection and post operative infection at remote sites.