Antibiotic prophylaxis for penetrating brain injury.

II. OVERVIEW The risk of intracranial infection among patients with PBI is high because of the presence of contaminated foreign objects, skin, hair, and bone fragments driven into the brain along the missile track. The presence of air sinus wounds or cerebrospinal fluid (CSF) fistulae may further increase the risk of infection. Since sulfa drugs were introduced just prior to World War II, all published studies have been of patients who received antibiotics after PBI. After World War II, the only studies of the infection rate in PBI are those in which all patients received prophylactic antibiotics. These data have been compared with preantibiotic series prior to World War II. Some conclusions may, in addition, be drawn from Class I and Class II studies that address the use of prophylactic antibiotics in clean elective neurosurgical procedures. Although the data on clean cases do not apply directly to the PBI population, their analysis can justifiably support recommendations for PBI patients at the level of Option. This section of the Guidelines is directed exclusively at infection prophylaxis, meaning when antibiotics are begun early after injury before there is any evidence of clinical infection. The management of established infections (e.g., wound infection, meningitis, or cerebral abscess) is not specifically addressed here.