Table 1.

Recommendation of antibiotic prophylaxis in neonatal and pediatric neurosurgery.

Type of Neurosurgical Procedure	Recommendation
Craniotomy or cranial/cranio-facial approach to craniosynostosis	Cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV administered 30 min before surgery is recommended. A further dose after 4 h should be given when the procedure lasts for a long time. In patients colonized by MRSA or MSSA who did not perform decolonization or if the patient cannot wait 5 days for decolonization pre-surgery, cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV combined with vancomycin at a dose of 15 mg/Kg (maximum dose 2 g) IV is recommended. Cefazolin should be administered 30 min before surgery, whereas vancomycin is recommended 90–120 min before.
Neurosurgery with a trans-nasal-trans-sphenoidal approach	Cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV administered 30 min before surgery is recommended. A further dose after 4 h should be given when the procedure lasts for a long time. In patients colonized by MRSA who did not perform MRSA decolonization pre-surgery, cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV combined with vancomycin at a dose of 15 mg/Kg (maximum dose 2 g) IV is recommended. Cefazolin should be administered 30 min before surgery, whereas vancomycin is recommended 90–120 min before.
Neurosurgery in non-penetrating head injuries	Cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV administered 30 min before surgery is recommended. A further dose after 4 h should be given when the procedure lasts for a long time.
Neurosurgery in penetrating head fracture	Amoxicillin-clavulanic acid at a dose of 30 mg/kg (maximum dose 1 g) IV or cefuroxime at a dose of 50 mg/kg (maximum dose 1.5 g) IV in association with metronidazole at a dose of 15 mg/kg (7.5 mg/kg in neonates weighing less than 1200 g; maximum dose 500 mg) IV is recommended. Administration should begin within 30 min before surgery and is recommended for 5 days.
Spinal surgery (extradural and intradural)	Cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV administered 30 min before surgery is recommended. A further dose after 4 h should be given when the procedure lasts for a long time. In patients colonized by MRSA or MSSA who did not perform decolonization pre-surgery or if the patient cannot wait 5 days for decolonization pre-surgery, cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV combined with vancomycin at a dose of 15 mg/Kg (maximum dose 2 g) IV is recommended. Cefazolin should be administered 30 min before surgery, whereas vancomycin is recommended 90–120 min before.
Shunt surgery or neuroendoscopy	Cefazolin at a dose of 30 mg/kg (maximum dose 2 g) IV administered 30 min before surgery is recommended. A further dose after 4 h should be given when the procedure lasts for a long time.
Neuroendovascular procedures	Not recommended