Guidelines for Pre-operative Antibiotics for Neurosurgery

Antibiotic Doses:

Ancef = 2 grams or 3 grams if >120 kg (30mg/kg in kids) re-dose q4 hr

Clinda = 900mg (10mg/kg in kids) re-dose q6 hr

Vanc = 15mg/kg no re-dosing

*Vanc Dosing –

In a study of 2048 patients undergoing coronary bypass graft or valve replacement surgery receiving vancomycin prophylaxis, the rate of SSI was lowest in those patients in whom an infusion was started 16–60 minutes before surgical incision.

Overall Recommendation on Timing:

Overall, administration of the first dose of antimicrobial beginning within 60 minutes before surgical incision is recommended. Administration of vancomycin and fluoroquinolones should begin within 120 minutes before surgical incision because of the prolonged infusion times required for these drugs. Because these drugs have long half-lives, this early administration should not compromise serum levels of these agents during most surgical procedures.

Population Studies Reveal:

  • S. aureus nasal colonization in the general population decreased from 32.4% in 2001–02 to 28.6% in 2003– 04 (p < 0.01), whereas the prevalence of colonization with MRSA increased from 0.8% to 1.5% (p < 0.05)
  • Between 2007 and 2009, 23.3% of children were colonized with S. aureus, but the proportion of children colonized with MRSA had increased from 8.1% in 2004 to 15.1% in 2009.

Official Recommendation Guideline for Neurosurgery Procedures

A single dose of cefazolin is recommended for patients undergoing clean neurosurgical procedures, CSF-shunting procedures, or intrathecal pump placement (Table 2). Clindamycin or vancomycin should be reserved as an alternative agent for patients with a documented b-lactam allergy (vancomycin for MRSA-colonized patients). (Strength of evidence for prophylaxis = A.)

Official Recommendation Guideline for Spine Procedures

Antimicrobial prophylaxis is recommended for orthopedic spinal procedures with and without instrumentation. The recommended regimen is cefazolin (Table 2). (Strength of evidence for prophylaxis in orthopedic spinal procedures = A.) Clindamycin and vancomycin should be reserved as alternative agents as described in the Common Principles section. If there are surveillance data showing that gram-negative organisms are a cause of SSIs for the procedure, practitioners may consider combining clindamycin or vancomycin with another agent (cefazolin if the patient is not b-lactam allergic; aztreonam, gentamicin, or single-dose fluoroquinolone if the patient is b-lactam allergic). Mupirocin should be given intranasally to all patients known to be colonized with S. aureus.

Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 2013 vol. 70 (3) pp. 195-283