Ethical issues in the history of prophylactic antibiotic use in neurosurgery.

There has always been controversy about the indications for prescribing antibiotics to prevent postoperative sepsis in patients undergoing cranial and spinal surgery. The earlier specialists in infectious diseases warned that the effectiveness of antimicrobial drugs was leading to indiscriminate administration for the prevention of wound infection. Three clinical researchers present a review of the history of prophylactic antibiotic use in neurosurgery, including their own work, and raise a number of ethical issues not previously discussed in the literature about: (1) scientific methodology; (2) random selection; (3) prospective study; (4) blinded control; (5) placebo medication; (6) professional equipoise; (7) statistical analysis; (8) informed consent; (9) utilitarian philosophy; and (10) managed care. Also discussed are the dual role of physician and investigator and the ethical dilemma of depending upon meticulous technique versus adopting regimens of prophylactic antibiotics.