Prophylactic antibiotics with intracranial pressure monitors and external ventricular drains: a review of the evidence

Surg Neurol. 1999 Sep;52(3):226-36; discussion 236-7. doi: 10.1016/s0090-3019(99)00084-1.


Background: The role of prophylactic antibiotics (PABs) in preventing infections associated with intracranial pressure (ICP) monitors and external ventricular drains (EVD) is not well defined.

Methods: This study includes an analysis of published reports and a survey of current practices regarding the use of PABs with ICP monitors and EVDs. A computerized data search and a review of the abstracts from two major national neurosurgical meetings over the past decade yielded 85 related articles. Three independent investigators, blinded to the title, author(s), institution(s), results, and conclusions of the articles used predetermined inclusion criteria to select studies for meta-analysis. Thirty-six responses were returned from 98 questionnaires (37%) mailed to university neurosurgical programs.

Results: Among the articles reviewed, only two studies met the predetermined inclusion criteria for the meta-analysis, and they were of insufficient size to produce statistically significant results. Among the 36 programs that responded to the survey, 26 (72%) used PABs, mainly cephalosporins (46%) and semisynthetic penicillins (38%), with ICP monitors and EVDs. Twenty-two (85%) used one drug, and 4 (15%) used two drugs. Twenty-two (61%) of the total group reported intra-institutional variation in practices among individual staff neurosurgeons. Nineteen (53%) expressed interest in a retrospective study, and 27 (75%) expressed interest in a prospective study on the role of PABs in minor neurosurgical procedures.

Conclusion: No consensus regarding the use of PABs with ICP monitors and EVDs is noted. Randomized controlled trials of sufficiently large size with appropriate blinding are needed to address this issue.

Publication types

  • Meta-Analysis

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis* / adverse effects
  • Antibiotic Prophylaxis* / economics
  • Bacterial Infections / economics
  • Bacterial Infections / etiology*
  • Bacterial Infections / prevention & control*
  • Cerebral Ventricles*
  • Drainage / adverse effects*
  • Drainage / economics
  • Drainage / instrumentation
  • Humans
  • Intracranial Pressure*
  • Monitoring, Physiologic / adverse effects*
  • Monitoring, Physiologic / economics
  • Neurosurgical Procedures / adverse effects*
  • Neurosurgical Procedures / economics
  • United States


  • Anti-Bacterial Agents