Comparison between Ceftriaxone and Co-trimoxazole in prevention of infection in cerebro-peritoneal shunt

Abstract

Background: Shunt infection, a common problem in shunt-inserted patients, is an important concern in neurosurgery. It increases mortality rate and causes developmental and cognitive delay in children. Use of antibiotics and selection of them in preventing shunt infection is controversial. In this randomized clinical trial, we compare the effect of ceftriaxone and co-trimoxazole in this concern.
Methods: We studied 85 hydrocephalous children hospitalized in Children’s Medical Center (2003-2004). Patients, aged 1 month to12 years, were divided into two similar groups (according to age, sex, and etiology of hydrocephaly), received one of both antibiotics pre-op and followed up for possible infection for one year.
Results: Shunt infection occurred in 10 patients aged 2-36 months <6 months after surgery (80%). We did not find any significant difference between the two antibiotics regarding infection prevention. The most effective factors in increasing shunt infection were low age of the patients and CSF leakage.
Conclusion: According to the ineffectiveness of antibiotics in preventing shunt infection, it seems that the risk can be reduced by controlling other factors like better sanitation and less traffic in operating rooms, faster surgery and decreasing chance of CSF leakage.