Prophylactic antibiotic treatment is only indicated in cases of penetrating spinal injury with concomitant gastrointestinal organ injury/violation, particularly colonic injuries or in cases of frank contamination.
There is little data on which to base firm recommendation for penetrating brain or spinal injuries. However, infection in this population is not uncommon and carries significant morbidity. Many institutions treat empirically, although studies to support an exact regimen and duration of treatment do not exist. The most commonly suggested regimen is listed above, however any combination adequately covering gram positive, gram negative and anaerobic pathogens is reasonable.
*Every Vancomycin order requires pharmacokinetic consult.