PROPHYLACTIC ANTIBIOTICS FOR POSTTRAUMATIC CEREBROSPINAL-FLUID FISTULAS - A METAANALYSIS

Objective: To determine the efficacy of prophylactic antibiotics in th e treatment of posttraumatic cerebrospinal fluid fistulae. Design: Met a-analysis with literature review. Methods: A MEDLINE search was perfo rmed to obtain all the reports pertaining to posttraumatic cerebrospin al fluid fistulae between 1970 and 1995. All the series that provided data specifying whether prophylactic antibiotics were provided and the incidence of meningitis were included in the analysis. Results: The f indings of 6 studies, involving 324 patients, were analyzed. In these studies, 237 received prophylactic antibiotics and 87 did not. Only 6 of the 237 patients who received prophylactic antibiotics developed me ningitis, yielding an incidence of 2.5%. Nine (10%) of the 87 patients who did not receive prophylactic antibiotics developed meningitis. Th e incidence of meningitis was significantly lower in the patients who received prophylactic antibiotics than in those who did not receive pr ophylaxis (Fisher exact test, P=.006). Conclusions: Individually, each of the studies included in this analysis demonstrated no significant difference in the incidence of meningitis with prophylactic antibiotic therapy. 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.