Administration of prophylactic antibiotics is not a proven or universal practice in cerebrospinal fluid (CSF) shunt surgery although case and operative infection rates in hydrocephalic patients average 20 and 8%, respectively. In sequential series from 1969 through 1978 the authors achieved a reduction in case infection rates from 10.9 to 8.9% and in operative infections from 8 to 2.6% with the use of short-term prophylactic methicillin. Comparison of these results to those of other reported series supports the case for short-term prophylactic antibiotics in shunt surgery. Further reduction in shunt sepsis may be possible with the appropriate selection of other semisynthetic penicillins which achieve higher levels in CSF.
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