Prophylactic antibiotics in the setting of cerebrospinal fluid fistula is controversial; however, Diaz et al. advocated its use due to a dedicated meta-analysis of Cerebrospinal fluid fistula specific to the lateral skull base 1).
Given the low incidence of meningitis in this subgroup and the lack of evidence demonstrating any benefit to prophylactic antibiotics 2) 3) 4) 5) 6) 7) 8) 9) 10) 11)
Villalobos et al. performed a formal systematic review of previously published studies after a computerized search with use of the MEDLINE data base (1970-1996). Fourteen studies were identified, and 12 studies met the criteria for inclusion. Study design and quality were assessed by two independent investigators with use of a predetermined protocol. A total of 1,241 patients with basilar skull fractures were included; 719 patients received antibiotics, and 522 patients did not receive antibiotics. Overall results suggest that antibiotic prophylaxis did not prevent meningitis among patients with basilar skull fractures (odds ratio [OR] = 1.15; 95% confidence interval [CI] = 0.68-1.94; P = .678). Patients with basilar skull fractures and Cerebrospinal fluid fistula were analyzed separately (OR = 1.34; 95% CI = 0.75-2.41; P = .358), as were children (OR = 1.04; 95% CI = 0.07-14.90; P = 1.000). Antibiotic prophylaxis after basilar skull fractures does not appear to decrease the risk of meningitis 12).