From the Research
Prophylactic antibiotics are generally not recommended for routine transforaminal epidural steroid injections (ESIs), as the procedure is considered clean and the risk of infection is extremely low (less than 0.1-0.01%). The potential harms of unnecessary antibiotic use, including allergic reactions, antibiotic resistance, and disruption of normal flora, outweigh the benefits in most cases 1. However, prophylactic antibiotics may be considered in specific high-risk patients, such as those who are immunocompromised, have diabetes with poor glycemic control, are on immunosuppressive medications, or have a history of previous spinal infection. In these cases, a single dose of cefazolin 1-2g IV (or clindamycin 600-900mg IV for those with penicillin allergy) 30-60 minutes before the procedure may be appropriate, as suggested by the most recent and highest quality study available 1.
Some key points to consider when deciding on prophylactic antibiotics for transforaminal ESIs include:
- The risk of infection from transforaminal ESIs is extremely low, and the benefits of prophylactic antibiotics do not outweigh the risks in most cases 1
- High-risk patients, such as those who are immunocompromised or have a history of previous spinal infection, may benefit from prophylactic antibiotics 1
- Proper sterile technique during the procedure remains the most important factor in preventing infection, including thorough skin preparation, sterile draping, and aseptic handling of equipment 1
- The decision to use prophylactic antibiotics should be individualized based on patient risk factors and institutional protocols 1
It's worth noting that the most recent and highest quality study available 1 provides the best evidence for guiding clinical practice, and its findings should be prioritized when making decisions about prophylactic antibiotics for transforaminal ESIs.