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

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.