Empirically adapted or personalized antibiotic prophylaxis in select cranial neurosurgery?

Excerpt

The development of a safe and effective antibiotic prophylaxis in surgery has been developing since the 1970s. A few groundbreaking publications have led to today’s concept of single-dose or ultra-short antibiotic prophylaxis in most surgical interventions including cranial neurosurgery. Over the decades, a few basic rules of antibiotic prophylaxis have evolved such as the avoidance of antibiotics which are first choice therapeutic agents, their application before skin incision, the appropriate selection of antibiotic agents effective against the expected pathogens, and the application of a single-dose or an ultra-short prophylaxis rather than extended regimes. By following these rules, the risk of the emergence of resistant strains is reduced to a minimum while providing a good safeguard against postoperative infections without spoiling potential candidates for an antibiotic therapy in the case of infection. Lately, several publications have surfaced dealing with the question which particular prophylactic regime is adequate and if antibiotic prophylaxis in cranial neurosurgery should be individually tailored or not [1, 2, 7]. Is it time to abandon empirically adapted and proven regimes of antibiotic prophylaxis for personalized regimes in endonasal skull base surgery and other selected cranial interventions? …