Professional Documents
Culture Documents
Christine Khan
All
Trustwide
Scope: Trustwide
Classification: Guideline
Keywords: Antibiotics,
Infection
Antibiotic
Prophylaxis in Neurosurgery
(December 2010)
Replaces:
Review Date:
December 2012
144TD(C)25(F4)
Issue Status:
Approved
Issue No: 2
2011
Medicines
management Group
Authorised by:
Authorisation Date: 12
th
September 2011
Y/N
If this policy is required for NHSLA evidence, then this document must have been checked
against the current standards for compliance. If this is not known by the author, confirmation
should be sought from the Risk and Health and Safety Department.
Issue [2]
[Sept 2011]
Page 1 of 11
Policy Statement
This policy applies to all clinical staff involved the prescribing of
antimicrobials.
Antimicrobial agents are among the most commonly prescribed drugs and
account for 20% of the hospital pharmacy budget. Unfortunately, the benefits
of antibiotics to individual patients are compromised by the development of
bacterial drug resistance. Resistance is a natural and inevitable result of
exposing bacteria to antimicrobials.
Good antimicrobial prescribing will help to reduce the rate at which antibiotic
resistance emerges and spreads. It will also minimise the many side effects
associated with antibiotic prescribing, such as Clostridium difficile infection. It
should be borne in mind that antibiotics are not needed for simple coughs and
colds. In some clinical situations, where infection is one of several possibilities
and the patient is not showing signs of systemic sepsis, a wait and see
approach to antibiotic prescribing is often justified while relevant cultures are
performed.
This document provides treatment guidelines for the most common situations
in which antibiotic treatment is required. The products and regimens listed
here have been selected by the Trust's Medicines Management Group on the
basis of published evidence. Doses assume a weight of 60-80kg with normal
renal and hepatic function. Adjustments may be needed for the treatment of
some patients.
This document provides treatment guidelines for the appropriate use of
antibiotics. The recommendations that follow are for empirical therapy and do
not cover all clinical circumstances. Alternative antimicrobial therapy may be
needed in up to 20% of cases. Alternative recommendations will be made by
the microbiologist in consultation with the clinical team.
This document refers to the treatment of adult patients (unless otherwise
stated).
Issue [2]
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Executive Summary
Issue [2]
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Page 3 of 11
Page 4 of 11
Neurosurgical procedure
/ operation
Prophylaxis
Cefuroxime 1.5 gm IV at
induction and every 4 hours
during surgery
Cefuroxime 1.5 gm IV at
induction and vancomycin 10
mg intraventricular instillation
External ventricular
drain (EVD) insertion
Penetrating
craniocerebral injuries
and depressed skull
fractures
Prophylaxis if allergic to
penicillin or known to be
colonised or infected with
MRSA at any site
Teicoplanin 400 mg IV at
induction
Cefuroxime 1.5 gm IV at
induction and vancomycin 10
mg intraventricular and
gentamicin 5 mg
intraventricular
instillation
Cefuroxime 1.5 gm IV at
induction
Cefuroxime 1.5 gm IV 8
hourly and metronidazole 500
mg IV 8 hourly for 5 days
Teicoplanin 400 mg IV at
induction and vancomycin 10 mg
intraventricular and gentamicin 5
mg intraventricular
instillation
Teicoplanin 400 mg IV at
induction
Discuss with Duty Microbiologist
Issue [2]
[Sept 2011]
Page 5 of 11
Neurosurgical
procedure / operation
Prophylaxis
Cefuroxime 1.5 gm IV at
induction and every 4
hours during surgery
Cefuroxime 1.5 gm IV
and metronidazole 500
mg IV at induction.
Postoperatively give 2
more doses of both the
antibiotics 8 hourly
Extensive anterior
fossa cranio-facial
resections
Issue [2]
[Sept 2011]
Page 6 of 11
Key References:
1. Infection in Neurosurgery Working Party of the British Society for
Antimicrobial Chemotherapy. Antimicrobial prophylaxis in neurosurgery
and after head injury. Lancet 1994; 344: 1547-1551.
2. Infection in Neurosurgery Working Party of the British Society for
Antimicrobial Chemotherapy. Use of antibiotics in penetrating
craniocerebral injuries. Lancet 2000; 355: 1813-1817.
3. Infection in Neurosurgery Working Party of the British Society for
Antimicrobial Chemotherapy. The management of neurosurgical
patients with post operative or aseptic meningitis or extended
ventricular drain associated ventriculitis. B J Neurosurg 2000; 14: 7-12.
Issue [2]
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Endorsed by:
Name of Lead Clinician/Manager or
Committee Chair
Date
Dr Paul Chadwick
August 2011
Dr Paul Chadwick
September 2011
Issue [2]
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italics)
Antibiotic prophylaxis in
Neurosurgery
Issue [2]
[Sept 2011]
NOT RECOMMENDED
Date: 7/7/05
Page 9 of 11
Reason
Change of guidelines
1a)
2a)
No
3a)
No
3b)
objectively justified)
4a)
N/A
5a)
Yes
Issue [2]
[Sept 2011]
Page 10 of 11
5b)
5c)
Yes
6a)
No
6b)
7) a) To summarise; is there any evidence to indicate that any groups listed below
receive different outcomes in relation to this document?
Yes
Positive
No
unsure
Negative*
Age
Disability
Sex
Race
Sexual orientation
Gender Reassignment
Carers *1
Socio/economic**2
1: That these two categories are not classed as protected groups under the Equality Act.
2: Care must be taken when giving due consideration to socio/economic group that we do
not inadvertently discriminate against groups with protected characteristics
Negative Impacts
*If any negative impacts have been identified you must either a) state below how you
have eliminated these within the policy or b) conduct a full impact assessment:
8) How will the future outcomes of this policy be monitored?
Regular audits
9) If any negative impact has been highlighted by this assessment, you will
need to undertake a full equality impact assessment:
Will this policy require a full impact assessment? Yes/No (delete)
(if yes please contact Equality Team, 62598/67204, for further guidance)
High/Medium/Low signed___________________________
date:
Issue [2]
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