Topical antibiotic prophylaxis in neurosurgery.

Topical antibiotics have been used prophylactically in clean operations by many neurosurgeons. Many others have not used them, however. Review of the experimental literature shows that topical antibiotics will reduce the rate of wound infection in experimentally contaminated wounds. Experience in other surgical disciplines suggests that the infection rate of operations with an intrinsically high risk of infection (greater than 15%) can be reduced substantially by the use of topical antibiotics. There is no sound scientific evidence documenting the benefit of prophylactic topical antibiotics in operations with a risk of infection below 5%. Reports of the use of topical antibiotics in neurosurgery are either uncontrolled or are so fragmentary that no useful-conclusions can be drawn from them. Surgical wounds with a high risk of infection should be treated with intraoperative topical antibiotics. The routine use of topical antibiotics in clean neurosurgical procedures requires further study.