Meningitis: prophylactic antibiotics for skull fracture had no clear effect.

Clinical bottom line (level 3a)

  1. Patients who have had a basilar skull fracture and were given prophylactic antibiotics, had no clear difference in rates of meningitis than those not given antibiotics.
Villalobos et al: Clinical Infectious Diseases 1998; 27: 364-369
Expires October 2003

The study

Systematic review of published studies of
  • Patients: basilar skull fracture
  • Intervention: prophylactic antibiotics compared with no antibiotics
  • Outcome: meningitis


    • Articles found in ? using MEDLINE, 1970 to 1996 (search terms: basilar skull fracture, meningitis and antibiotics ) and Bibliographies of all relevant original articles and review articles were examined to identify any additional studies.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: not able to extract specific data

    12 studies of 1241 patients (9 retrospective, 2 prospective and randomised and 1 combined prospective-retrospective study)
    • Different antibiotic regimens were used in the various studies- penicillins, first-generation cephalosporins, third-generation cephalosporins, ceftiaxone, ampicillin/sulphadiazine, chloramphenicol, sulphonamides and gentamycin in combination with penicillin.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    prevention of meningitis (all studies) unknown 37/522
    (7.00%)    		 1.15
    (0.68 to 1.94)     		103
    (NNT = 17 to infinity;
    NNH = 47 to infinity)
    prevention of meningitis (prospective studies only) weeks 2/89
    (2.25%)    		 0.68
    (0.01 to 13.77)     		141
    (NNT = 45 to infinity;
    NNH = 5 to infinity)
    prevention of meningitis (retrospective studies) weeks 36/433
    (8.31%)    		 1.17
    (0.68 to 2.01)     		-78
    (NNT = 40 to infinity;
    NNH = 14 to infinity)

    Comments

    1. The meta-analysis is too small to show any clear difference in meningitis contraction between the two groups.
    2. The dominating amount of retrospective studies included in the analysis may lead to noise, if not bias, in the final results.

    Citation

    1. Villalobos T, Arango C, Kubilis P, et al: Antibiotic prophylaxis after basilar skull fracture: A meta-analysis. Clinical Infectious Diseases 1998; 27: 364-369
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer: Dirk Stengel

    Clinical Question.
    Patient basilar skull fracture
    Intervention or Exposure antibiotics
    Comparison no antibiotics
    Outcome meningitis