THE USE OF PROPHYLACTIC SYSTEMIC ANTIBIOTICS IN COMPOUND DEPRESSED SKULL FRACTURES IN INFANCY AND CHILDHOOD

The use of prophylactic antibiotics in compound depressed skull fractures (CDSF) is not generally accepted 2 » * A 7 » 1 2. The great majority of pediatric neurosurgeons recommend systemic prophylactic antibiotics when fractures are open or when bone fragments are replaced, to prevent local and systemic infection 3,8,10,11,12,14. The purpose of this paper is to report our experience with the treatment of 60 patients with CDSF younger than 13 years treated in the hospital from 1970 to 1980. The results of the treatment of these patients with and without systemic prophylactic antibiotics and the correlation of the infection rate with and without the replacement of bone fragments were discussed. CLINICAL MATERIAL 60 patients with CDSF (36 from Toronto and 24 from S&o Paulo) were included in this study, 36 were boys and 21 girls and the age ranged from 3 to 13 years old and underwent four kinds of treatment. The patients were divided into 4 groups with 15 patients each. let group — patients receive systemic antibiotics, and bone fragments were discar-ted; 2nd group — patients didn't receive systemic antibiotics and bone fragments were discarted; 3rd group — patients receive systemic antibiotics and bone fragments were replaced; 4th group — patients didn't receive systemic antibiotics and bone fragments were replaced. In all cases the surgical treatment was carried out during the first 24 hours after the accident. The first aids were the same in all cases. During the preoperative phase a copious washing with Phieiohex and saline solution of the skull and wound were performed. The operative procedure consisted of debridement of the wounds and of the usual treatment of the dural laceration and/or laceration of the brain. Irrigation with Bacitracin and saline solution was made in all cases from Toronto and Gentamicin and saline solution in all cases from São Paulo