Cefepime vs. Ampicillin/Sulbactam and Aztreonam as antibiotic prophylaxis in neurosurgical patients with external ventricular drain: result of a prospective randomized controlled clinical trial

Summary Introduction:  We aimed to find out whether single board spectrum antibiotic prophylaxis was as good as dual specific antibiotic prophylaxis in neurosurgical patients with external ventricular drain (EVD) in situ . Method:  In a 2‐year period, 255 eligible patients were recruited. Patients were randomized into two groups of antibiotic prophylaxis as long as the ventricular catheter in situ . Group A employed Cefepime 2G 12 hourly and Group B employed dual antibiotics as Ampicillin/Sulbactam 3 g 8 hourly and Aztrenam 2 g 8 hourly. Results:  There was no statistically significant difference in cerebrospinal fluid (CSF) infection rate with 14 patients (11·5%) in group A (Cefepime prophylaxis) and eight patients (6·0%) in group B (dual prophylaxis with Ampicillin/Sulbactam and Aztrenam) had CSF infection ( P  = 0·18). There was also no statistical significant difference between wound infection rate happened in eight patients (6·6%) in Group A and three patients (2·3%) in Group B ( P  = 0·17). There was no statistical significant difference in extracranial infection rate between both groups ( P  = 0·70). Conclusion:  Single board spectrum antibiotic prophylaxis with Cefepime was an effective alternative regimen for neurosurgical patients with an EVD in situ .