Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistula
The rate of central nervous system infection (CNSI) is marginal and antibiotics do not appear to confer a protective advantage. A larger trial is needed to elucidate the true effect of antibiotics on preventing CNSIs in patients with posttraumatic pneumocephalus or cerebrospinal fluid leak 1).
In a meta-analysis individually, each of the studies included in an analysis demonstrated no significant difference in the incidence of meningitis with prophylactic antibiotics. The reason for this is that inadequate numbers of patients were available at each institution. Pooling the data from the past 25 years revealed a statistically significant reduction in the incidence of meningitis with prophylactic antibiotic therapy 2).
Prophylactic antibiotics is an option and not a recommendation 3).