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. 2019 Jun 4;2019(6):CD012902. doi: 10.1002/14651858.CD012902.pub2

Bullock 1988.

Methods Randomized, controlled
Method of randomisation: unclear
Kind of shunt: ventriculoperitoneal shunts
Location: South Africa
Follow‐up: 90 days after surgery
Duration: unclear
Participants Inclusion: patients undergoing "clean" neurosurgical operative procedures
Exclusion: patients with known piperacillin hypersensitivity or allergy, patients who had undergone a neurosurgical operation within a month prior to study and patients who had received any antibiotic therapy within 7 days prior to the study
Treatment: 48, control 48
Interventions Piperacillin IV 35 mg/kg 30 to 60 minutes prior to surgery and 2 doses at 6 and 12 hours postoperatively
Control: placebo (saline)
Outcomes Sepsis (wound, meningitis)
3 cases of sepsis occurred within 22 days after surgery
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not described
Allocation concealment (selection bias) Low risk "Allocation of antibiotic or placebo was carried out using a random number list"
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk "Investigators remained blinded until the end of the study"
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Not described
Incomplete outcome data (attrition bias) 
 All outcomes Low risk 20 participants were excluded, exclusions were well described. A Chi² test was performed in order to check for statistically significant differences between exclusions in the treatment and placebo group. No statistical difference was found
Selective reporting (reporting bias) Unclear risk Not well described
Other bias Unclear risk 35 protocol deviations occurred, which could cause bias in outcome, even when statistical analysis both including and excluding these protocol deviations show no statistical differences