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

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

“…6 Similarly, patients with basilar skull fractures and CSF leak were not at increased risk of developing meningitis compared to patients without CSF leak in a separate study by Ratilal and colleagues. 3 Both studies support our finding that antibiotic prophylaxis does not reduce the risk of CNS infections in patients with traumatic pneumocephalus or CSF leak.…”

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

“…6 Similarly, patients with basilar skull fractures and CSF leak were not at increased risk of developing meningitis compared to patients without CSF leak in a separate study by Ratilal and colleagues. 3 Both studies support our finding that antibiotic prophylaxis does not reduce the risk of CNS infections in patients with traumatic pneumocephalus or CSF leak.…”

ICAR: endoscopic skull‐base surgery

“…The frequency of meningitis in the treatment group was 6.92%, and 6.52% in the control group. Although these results were comparable to the analyses using the 5 RCTs, another subgroup analysis within the non‐RCT trials identified a possible small benefit with antibiotic prophylaxis in patients with CSF leakage . However, interpretation is cautioned within this group because of limitations of the nonrandomized, retrospective nature and variable reporting within the studies.…”

Early Treatment of Cerebrospinal Fluid Leakage After Traumatic Injury Using Pedicled Autologous Fascia Flap

“…Treatment modalities vary, with nonsurgical interventions recommended for low-pressure leaks, and surgery advised for high-pressure or delayed leaks. Controversy exists regarding lumbar pool drainage and prophylactic antibiotics 7–9 . In our study, all cases necessitated surgical intervention due to traumatic craniocerebral injury and associated CSF leakage.…”

“…Controversy exists regarding lumbar pool drainage and prophylactic antibiotics. [7][8][9] In our study, all cases necessitated surgical intervention due to traumatic craniocerebral injury and associated CSF leakage.…”

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

“…6 Similarly, patients with basilar skull fractures and CSF leak were not at increased risk of developing meningitis compared to patients without CSF leak in a separate study by Ratilal and colleagues. 3 Both studies support our finding that antibiotic prophylaxis does not reduce the risk of CNS infections in patients with traumatic pneumocephalus or CSF leak.…”

ICAR: endoscopic skull‐base surgery

“…The frequency of meningitis in the treatment group was 6.92%, and 6.52% in the control group. Although these results were comparable to the analyses using the 5 RCTs, another subgroup analysis within the non‐RCT trials identified a possible small benefit with antibiotic prophylaxis in patients with CSF leakage . However, interpretation is cautioned within this group because of limitations of the nonrandomized, retrospective nature and variable reporting within the studies.…”

Early Treatment of Cerebrospinal Fluid Leakage After Traumatic Injury Using Pedicled Autologous Fascia Flap

“…Treatment modalities vary, with nonsurgical interventions recommended for low-pressure leaks, and surgery advised for high-pressure or delayed leaks. Controversy exists regarding lumbar pool drainage and prophylactic antibiotics 7–9 . In our study, all cases necessitated surgical intervention due to traumatic craniocerebral injury and associated CSF leakage.…”

“…Controversy exists regarding lumbar pool drainage and prophylactic antibiotics. [7][8][9] In our study, all cases necessitated surgical intervention due to traumatic craniocerebral injury and associated CSF leakage.…”

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

“…6 Similarly, patients with basilar skull fractures and CSF leak were not at increased risk of developing meningitis compared to patients without CSF leak in a separate study by Ratilal and colleagues. 3 Both studies support our finding that antibiotic prophylaxis does not reduce the risk of CNS infections in patients with traumatic pneumocephalus or CSF leak.…”

ICAR: endoscopic skull‐base surgery

“…The frequency of meningitis in the treatment group was 6.92%, and 6.52% in the control group. Although these results were comparable to the analyses using the 5 RCTs, another subgroup analysis within the non‐RCT trials identified a possible small benefit with antibiotic prophylaxis in patients with CSF leakage . However, interpretation is cautioned within this group because of limitations of the nonrandomized, retrospective nature and variable reporting within the studies.…”

Early Treatment of Cerebrospinal Fluid Leakage After Traumatic Injury Using Pedicled Autologous Fascia Flap

“…Treatment modalities vary, with nonsurgical interventions recommended for low-pressure leaks, and surgery advised for high-pressure or delayed leaks. Controversy exists regarding lumbar pool drainage and prophylactic antibiotics 7–9 . In our study, all cases necessitated surgical intervention due to traumatic craniocerebral injury and associated CSF leakage.…”

“…Controversy exists regarding lumbar pool drainage and prophylactic antibiotics. [7][8][9] In our study, all cases necessitated surgical intervention due to traumatic craniocerebral injury and associated CSF leakage.…”