ANTIBIOTIC-PROPHYLAXIS AFTER BASILAR SKULL FRACTURES - A METAANALYSIS

Antibiotic prophylaxis after basilar skull fractures remains controver sial. Previous studies have not clearly delineated the utility of prop hylactic antibiotics in this setting. We undertook this study to deter mine if antibiotic prophylaxis after basilar skull fractures prevented meningitis. We performed a formal systematic review of previously pub lished studies after a computerized search with use of the MEDLINE dat a base (1970-1996). Fourteen studies were identified, and 12 studies m et 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 a ntibiotics. Overall results suggest that antibiotic prophylaxis did no t 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 leaka ge 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). Antibio tic prophylaxis after basilar skull fractures does not appear to decre ase the risk of meningitis.