Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

Abstract

In patients with basilar skull fracture, there is inadequate evidence to recommend for or against antibiotic prophylaxis in the prevention of meningitis, irrespective of cerebrospinal fluid leakage. METHODS DATA SOURCES The authors electronically searched the Cochrane Central Register of Controlled Trials (February 2011), MEDLINE, EMBASE, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and hand searched abstracts of neurosurgical conference proceedings and reference lists. Experts in the field were contacted to request additional sources. No language or publication restrictions were applied. STUDY SELECTIONStudies were included if they were randomized controlled trials comparing antibiotics versus placebo or no intervention after basilar skull fracture. Primary outcome was the development of meningitis. Similar observational trials were also identified for inclusion in a separate meta-analysis. Three authors independently identified potentially suitable articles from the search strategy, and disagreements were resolved by discussion with the fourth author. DATA EXTRACTION AND SYNTHESISTwo authors independently extracted data with standardized data collection forms and globally

Review article: Maxillofacial emergencies: Maxillofacial trauma

“…48 Patients with CSF leakage and fractures involving sinus and orbit communication may be at risk; however, the current literature does not support antibiotic prophylaxis based on incomplete and potentially biased evidence. 48,49 Ultimately opinion should be sought from the treating surgical team.…”

What is the efficacy of prophylactic antibiotics in basilar skull fractures?

“…However, the odds of developing meningitis were not significantly different between the two groups compared in the study (18.9% in the antibiotic group vs. 21.4% in the control group), even if adjusted for the presence of CSF leakage (OR 1.00; 95% CI 0.09-11.03). 4 Ratilal et al 1 conducted a systematic review of five randomized controlled trials (RCTs) and 17 nonrandomized controlled trials (non-RCTs) to determine the efficacy of prophylactic antibiotics in preventing meningitis in basilar skull fracture patients. The primary outcome investigated in all studies was the frequency of meningitis.…”

“…Regarding adverse effects of prophylactic antibiotics, the studies did not discuss any antibiotic-related complications or increased antibiotic resistance. [1][2][3][4]…”

“…It is thought that basilar skull fractures expose the central nervous system to contamination by bacteria from the nose and throat, thereby increasing the risk of meningitis. 1 However, several large meta-analyses provide conflicting reports; some recommend prophylactic antibiotics when CSF fistula is present, while others argue that prophylactic antibiotics do not significantly affect the incidence of posttraumatic meningitis. [1][2][3] While the incidence of meningitis in patients with basilar skull fractures is not common (9.2-17.8%), could prophylactic antibiotics further decrease complications of basilar skull fractures and reduce morbidity and mortality in head trauma patients?…”

“…1 However, several large meta-analyses provide conflicting reports; some recommend prophylactic antibiotics when CSF fistula is present, while others argue that prophylactic antibiotics do not significantly affect the incidence of posttraumatic meningitis. [1][2][3] While the incidence of meningitis in patients with basilar skull fractures is not common (9.2-17.8%), could prophylactic antibiotics further decrease complications of basilar skull fractures and reduce morbidity and mortality in head trauma patients? 4 Conversely, do routine prophylactic antibiotics given to basilar skull fracture patients contribute to the development of multidrug resistant organisms and a rise in health care costs?…”