Mallucci CL, Jenkinson MD, Conroy EJ, et al. - Through a parallel, multicentre, single-blind, randomized controlled trial of 3,505 patients with hydrocephalus of any etiology who were undergoing insertion of their first ventriculoperitoneal shunt irrespective of age at 21 regional adult and pediatric neurosurgery centers in the UK and Ireland, researchers ascertained the clinical and cost-efficiency of antibiotic (rifampicin and clindamycin) or silver shunts in comparison with standard shunts at decreasing infection. A total of 32 of 533 assessable patients in the standard shunt group had a shunt revision for infection, compared with 12 of 535 assessable patients in the antibiotic shunt group and 31 of 526 patients in the silver shunt group. In the standard shunt group, in the antibiotic shunt group, and in the silver shunt group, 135 patients, 127, and 134, respectively, had adverse events, which were not life-threatening and were mostly associated with valve or catheter function. Therefore, this trial gives evidence to support the adoption of antibiotic shunts in UK patients who are undergoing their first ventriculoperitoneal shunt insertion. This practice will profit patients of all ages by decreasing the risk and harm of shunt infection.