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Dear Editor

We would like to express our appreciation for the study titled “Efficiency of Topical Rifampin on Infection in Open Neural Tube Defects: A Randomized Controlled Trial.”[1] This research provides valuable insights into the potential benefits of topical rifampin for infection prevention in open neural tube defects (NTDs). However, we would like to highlight several aspects of the study that need further consideration and discussion.

Firstly, the study does not explicitly mention the duration of the follow-up period. Infections related to ventriculoperitoneal (VP) shunts, in particular, may develop later.[2] Therefore, extending the follow-up period could provide a more comprehensive assessment of rifampin’s long-term efficacy and safety. Another area of concern is the lack of detail regarding adverse events monitoring. Although the study reports no observed side effects, a more thorough description of the monitoring procedures for potential adverse events associated with rifampin would be beneficial. This would help clarify the safety profile of rifampin in this context.

Furthermore, the study reports a statistically significant higher rate of cerebrospinal fluid (CSF) sac ruptures in the rifampin group (p=0.006)[1]. However, the discussion does not explore the potential reasons behind this finding. This aspect warrants further investigation or at least a discussion on its clinical relevance.

Lastly, the study focuses specifically on paraplegic newborns with open NTDs. It would be helpful to explain the rationale for including only paraplegic cases and whether the findings can be generalized to non-paraplegic patients with open NTDs. There is another study on the same topic titled “Powder Topical Rifampin for Reducing Infections After Neural Tube Defect Surgery in Infants”[3], which considered both paraplegic and non-paraplegic cases. The results showed that in the post-operative period, meningitis or VP shunt infections were observed in 6.7% of patients, and surgical site infections (SSI) occurred in 3.3% of the experimental group treated with topical rifampin.[3]

Addressing these points could enhance the robustness and applicability of the study’s findings. Thank you for considering our observations.

References:

1. Deger, I.; et al. Efficiency of topical rifampin on infection in open neural tube defects: a randomized controlled trial. Int. J. Neurosci. 2021, 131(12), 1215--1220. [Google Scholar] [PubMed]

2. Pettorini, B.; Williams, D. The unwell child with a ventriculo-peritoneal shunt. Paediatr. Child Health 2015, 25(11), 533--534. [Google Scholar] [PubMed]

3. Demir, N.; et al. Powder Topical Rifampin for Reducing Infections After Neural Tube Defect Surgery in Infants. World Neurosurg. 2016, 95, 165--170. [Google Scholar] [PubMed]