Neurosurgery

Includes 

• Clean, clean-contaminated surgery
  • Craniotomy, aneurysm clipping
• Surgery with device implantation
  • VP/VA shunt, EVDs, spinal metalwork, DBS (EXCEPT replacement of known or suspected infected VP/VA shunt, DBS or spinal metalwork, see below)
• Spinal surgery including cervical spinal surgery (oral route)
• Contaminated surgery 
  • brain abscess, sub-dural empyema, penetrating intracranial wound/ gunshot, spinal infection

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below) AND gentamicin 3mg/kg iv

Note: Prophylaxis for high-risk neurosurgery i.e

• Have underlying malignancy
• Prolonged surgical procedure
• On high dose steroids
• Have had cranial radiotherapy
• Have diabetes mellitus 

cefazolin iv may be continued for up to 24 hours from start of operation (max dose 12g in 24 hours). Re-dose gentamicin one time only intra-operatively if surgery lasts longer than 6 hours.  See general principles. 

For penicillin allergy (severe) or MRSA positive patients:

teicoplanin 800mg iv AND gentamicin 3mg/kg iv

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below) AND gentamicin 3mg/kg iv

For penicillin allergy (severe) or MRSA positive patients: teicoplanin 800mg iv AND gentamicin 3mg/kg iv 

Post-operatively: 

Preferred (including for penicillin allergy non-severe): cefalexin 1g po tds for 3 days

For penicillin allergy severe OR MRSA positive: doxycycline 100mg po bd for 3 days 

Replacement or manipulation of known or suspected infected VP/VA shunt, DBS or spinal metalwork

teicoplanin 800mg iv + gentamicin 3mg/kg iv

No antibiotics unless infection suspected, then start treatment for meningitis Meningitis: post-neurosurgical infection