Antibiotic Prophylaxis for Preventing Meningitis in Patients With Basilar Skull Fractures: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

Ratilal B , Costa J

Department of Neurosurgery, Hospital de São José, Rua José António Serrano, Lisboa, Portugal, 1400-350;

Corresponding author：

Keywords：

Antibiotic prophylaxis; Basilar skull fractures; Meningitis; Systematic review

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Objectives 　We tended to evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF.
Method 　We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to September 2005), EMBASE (1974 to June 2005), and LILACS (1982 to September 2005). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). Randomized controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention were identified. We also identified non-RCTs to perform a separate meta-analysis to compare results. At least two authors independently appraised the quality and extracted the data of each trial. Meta-analysis was conducted using RevMan 4.2 software.
Results 　Five RCTs and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with BSF were identified. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the four RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality, and need for surgical correction in patients with CSF leakage. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2 168 patients), producing results consistent with the randomised data.
Conclusions 　Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.

Citation： Ratilal B,Costa J,Sampaio C. Antibiotic Prophylaxis for Preventing Meningitis in Patients With Basilar Skull Fractures: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(8): 576-585. doi: Copy

1.	Buchanan RJ, Brant A, Marshall LR. Traumatic cerebrospinal fluid fistulas. In: Winn H, editor(s). Youmans Neurological Surgery. 5th edition. Philadelphia: Saunders. 2004;5265-5272.
2.	Leech PJ, Paterson A. Conservative and operative management of cerebrospinal fluid leakage after closed head injury. Lancet, 1973;1 (7811):1013-1016.
3.	Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Br J Neurosurg, 1996;10(6):571-575.
4.	Brodie HA. Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae:A meta-analysis. Arch Otolaryngol Head Neck Surg,1997;123(7):749-752.
5.	Villalobos T, Arango C, Kubilis P, et al. Antibiotic prophylaxis after basilar skull fractures: a meta-analysis. Clin Infect Dis, 1998; 27(2):364-369.
6.	Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ, 1994; 309(6964):1286-1291.
7.	Egger M, Smith GD, Altman DG. Systematic reviews in health care. Meta-analysis in context. 2nd edition. London: BMJ Books, 2001.
8.	Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury, 1992;23(6):377-380.
9.	Eftekhar B, Ghodsi M, Nejat F, et al. Prophylactic administration of ceftriaxone for the prevention of meningitis after traumatic pneumocephalus: results of a clinical trial. J Neurosurg, 2004;101(5):757-761.
10.	Hoff JT, Brewin A, Hoi Sang U. Antibiotics for basilar skull fracture [letter]. J Neurosurg,1976;44(5):649.
11.	Ignelzi R, VanderArk G. Analysis of the treatment of basilar skull fractures with and without antibiotics. J Neurosurg., 1975;43(6):721-726.
12.	Klastersky J, Sadeghi M, Brihaye J. Antimicrobial prophylaxis in patients with rhinorrhea or otorrhea: a double blind study. Surgical Neurology, 1976;6(2):111-114.
13.	Eljamel MS. Antibiotic prophylaxis in unrepaired CSF fistulae. British Journal of Neurosurgery, 1993;7(5):501-505.
14.	Ash GJ, Peter J, Bass DH. Antimicrobial prophylaxis for fractured base of skull in children. Brain Injury, 1992;6(6):521-527.
15.	Gonzalez JL. Antibiotic prophylaxis in basilar skull fractures. Is it worth it? [Profilaxis con antibioticos en fracturas de base de craneo. Tiene justification esa conducta?]. Revista Cubana de Cirugía, 1998;37(2):5-9.
16.	Helling TS, Evans LL, Fowler DL, Hays LV, Kennedy FR. Infectious complications in patients with severe head injury. Journal of Trauma, 1988;28(11):1575-1577.
17.	Ignelzi R, VanderArk G. Analysis of the treatment of basilar skull fractures with and without antibiotics. Journal of Neurosurgery, 1975;43(6):721-726.
18.	Tos M. Course of and sequelae to 248 petrosal fractures. Acta Otolaryngologica (Stockholm), 1973;75(4):353-354.
19.	Einhorn A, Mizrahi EM. Basilar skull fractures in children. The incidence of CNS infection and the use of antibiotics. Am J Dis Child, 1978;132(11):1121-1124.
20.	Frazee RC, Mucha P Jr, Farnell MB, et al. Meningitis after basilar skull fracture. Does antibiotic prophylaxis help? Postgraduate Medicine, 1988;83(5):267-274.
21.	Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg, 2001;25(8):1062-1066.
22.	MacGee EE, Cauthen JC, Brackett CE. Meningitis following acute traumatic cerebrospinal fluid fistula. J Neurosurg, 1970;33(3):312-316.
23.	McGuirt WF Jr, Stool SE. Cerebrospinal fluid fistula: the identification and management in pediatric temporal bone fractures. Laryngoscope, 1995;105(4 Pt 1):359-364.
24.	Zrebeet HA, Huang PS. Prophylactic antibiotics in the treatment of fractures at the base of the skull. Del Med J.,1986;58(11):741-748.
25.	Dagi TF, Meyer FB, Poletti CA. The incidence and prevention of meningitis after basilar skull fracture. Am J Emerg Med, 1983;1(3):295-298.
26.	Clemenza JW, Kaltman SI, Diamond DL. Craniofacial trauma and cerebrospinal fluid leakage: a retrospective clinical study. J Oral Maxillofac Surg, 1995;53(9):1004-1007.
27.	Raskind R. Cerebrospinal fluid rhinorrhea and otorrhea. Diagnosis and treatment in 35 cases. J Int Coll Surg, 1965;43:141-154.
28.	Steidtmann K, Welge-Lussen A, Probst R. Antibiotikaprophylaxe bei laterobasalen frakturen [Antibiotic prophylaxis in laterobasal fractures]. HNO, 1997;45(6):448- 452.
29.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials, 1996;17(1):1-12.

1. Buchanan RJ, Brant A, Marshall LR. Traumatic cerebrospinal fluid fistulas. In: Winn H, editor(s). Youmans Neurological Surgery. 5th edition. Philadelphia: Saunders. 2004;5265-5272.
2. Leech PJ, Paterson A. Conservative and operative management of cerebrospinal fluid leakage after closed head injury. Lancet, 1973;1 (7811):1013-1016.
3. Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Br J Neurosurg, 1996;10(6):571-575.
4. Brodie HA. Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae:A meta-analysis. Arch Otolaryngol Head Neck Surg,1997;123(7):749-752.
5. Villalobos T, Arango C, Kubilis P, et al. Antibiotic prophylaxis after basilar skull fractures: a meta-analysis. Clin Infect Dis, 1998; 27(2):364-369.
6. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ, 1994; 309(6964):1286-1291.
7. Egger M, Smith GD, Altman DG. Systematic reviews in health care. Meta-analysis in context. 2nd edition. London: BMJ Books, 2001.
8. Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury, 1992;23(6):377-380.
9. Eftekhar B, Ghodsi M, Nejat F, et al. Prophylactic administration of ceftriaxone for the prevention of meningitis after traumatic pneumocephalus: results of a clinical trial. J Neurosurg, 2004;101(5):757-761.
10. Hoff JT, Brewin A, Hoi Sang U. Antibiotics for basilar skull fracture [letter]. J Neurosurg,1976;44(5):649.
11. Ignelzi R, VanderArk G. Analysis of the treatment of basilar skull fractures with and without antibiotics. J Neurosurg., 1975;43(6):721-726.
12. Klastersky J, Sadeghi M, Brihaye J. Antimicrobial prophylaxis in patients with rhinorrhea or otorrhea: a double blind study. Surgical Neurology, 1976;6(2):111-114.
13. Eljamel MS. Antibiotic prophylaxis in unrepaired CSF fistulae. British Journal of Neurosurgery, 1993;7(5):501-505.
14. Ash GJ, Peter J, Bass DH. Antimicrobial prophylaxis for fractured base of skull in children. Brain Injury, 1992;6(6):521-527.
15. Gonzalez JL. Antibiotic prophylaxis in basilar skull fractures. Is it worth it? [Profilaxis con antibioticos en fracturas de base de craneo. Tiene justification esa conducta?]. Revista Cubana de Cirugía, 1998;37(2):5-9.
16. Helling TS, Evans LL, Fowler DL, Hays LV, Kennedy FR. Infectious complications in patients with severe head injury. Journal of Trauma, 1988;28(11):1575-1577.
17. Ignelzi R, VanderArk G. Analysis of the treatment of basilar skull fractures with and without antibiotics. Journal of Neurosurgery, 1975;43(6):721-726.
18. Tos M. Course of and sequelae to 248 petrosal fractures. Acta Otolaryngologica (Stockholm), 1973;75(4):353-354.
19. Einhorn A, Mizrahi EM. Basilar skull fractures in children. The incidence of CNS infection and the use of antibiotics. Am J Dis Child, 1978;132(11):1121-1124.
20. Frazee RC, Mucha P Jr, Farnell MB, et al. Meningitis after basilar skull fracture. Does antibiotic prophylaxis help? Postgraduate Medicine, 1988;83(5):267-274.
21. Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg, 2001;25(8):1062-1066.
22. MacGee EE, Cauthen JC, Brackett CE. Meningitis following acute traumatic cerebrospinal fluid fistula. J Neurosurg, 1970;33(3):312-316.
23. McGuirt WF Jr, Stool SE. Cerebrospinal fluid fistula: the identification and management in pediatric temporal bone fractures. Laryngoscope, 1995;105(4 Pt 1):359-364.
24. Zrebeet HA, Huang PS. Prophylactic antibiotics in the treatment of fractures at the base of the skull. Del Med J.,1986;58(11):741-748.
25. Dagi TF, Meyer FB, Poletti CA. The incidence and prevention of meningitis after basilar skull fracture. Am J Emerg Med, 1983;1(3):295-298.
26. Clemenza JW, Kaltman SI, Diamond DL. Craniofacial trauma and cerebrospinal fluid leakage: a retrospective clinical study. J Oral Maxillofac Surg, 1995;53(9):1004-1007.
27. Raskind R. Cerebrospinal fluid rhinorrhea and otorrhea. Diagnosis and treatment in 35 cases. J Int Coll Surg, 1965;43:141-154.
28. Steidtmann K, Welge-Lussen A, Probst R. Antibiotikaprophylaxe bei laterobasalen frakturen [Antibiotic prophylaxis in laterobasal fractures]. HNO, 1997;45(6):448- 452.
29. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials, 1996;17(1):1-12.

Chinese Journal of Evidence-Based Medicine

Antibiotic Prophylaxis for Preventing Meningitis in Patients With Basilar Skull Fractures: A Systematic Review

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