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Volume 41, Number 2, April 2008
| | A randomized trial of ceftriaxone versus trimethoprim-sulfamethoxazole to prevent ventriculoperitoneal shunt infection |
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Farideh Nejat1, Parvin Tajik2, Mostafa El Khashab3, Syed Shuja Kazmi1, Ghamar Taj Khotaei4, Shahrzad Salahesh1
Departments of 1Neurosurgery, Children’s Hospital Medical Center and 2Epidemiology and Biostatistics, School of Public Health, Medical Sciences/University of Tehran, Tehran, Iran; 3Department of Neurosurgery, Children’s Medical Center, Dallas, Texas, USA; and 4Department of Infectious Diseases, Children’s Hospital Medical Center, Medical Sciences/University of Tehran, Tehran, Iran
Received: May 31, 2006 Revised: December 2, 2006 Accepted: January 22, 2007
Corresponding author: Dr. Farideh Nejat, M.D., Children’s Hospital Medical Center, Medical Sciences/University of Tehran, Tehran, Iran. E-mail:
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Background and Purpose: Shunt infection represents a particularly morbid condition, which can also result in mortality. In order to decrease the high morbidity and mortality rates, prevention is an essential step. The purpose of this study was to compare the prophylactic use of ceftriaxone and trimethoprim-sulfamethoxazole (SXT) for the prevention of ventriculoperitoneal (VP) shunt infection.
Methods: In this prospective, single-institution, randomized clinical trial, 107 children with hydrocephalus and an indication for shunting were randomly assigned to prophylaxis with ceftriaxone (n = 50) or SXT (55), each administered as a single dose during anesthesia and two divided doses postoperatively. Patients were followed up for at least one year.
Results: The mean age of patients was 15 months, and 85% were aged 6 months or younger. During the first postoperative year, meningitis occurred in 13.5% of patients receiving ceftriaxone and 14.5% of the SXT group, with no statistically significant difference between the groups. Younger age, presence of cerebrospinal fluid leakage and aqueductal stenosis as a cause of hydrocephalus showed significant correlation with meningitis occurrence on univariate analysis. However, only the latter 2 factors were associated with meningitis on multivariate analysis. The risk of shunt infection did not correlate with the gender of the patient, time of VP shunt surgery, or duration of hospitalization for shunting.
Conclusion: Ceftriaxone and SXT showed similar efficacy in preventing shunt infection. Cerebrospinal fluid leakage before or after VP shunt placement and aqueductal stenosis were independent risk factors for meningitis after VP shunt.
Key words: Antibiotic prophylaxis; Ceftriaxone; Meningitis; Trimethoprim-sulfamethoxazole combination; Ventriculoperitoneal shunt
J Microbiol Immunol Infect. 2008;41:112-117.
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