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Antibiotics in base of skull fractures
  1. John Butler,
  2. Simon Carley
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by John Butler, Specialist Registrar Search checked by Simon Carley, Specialist Registrar

    Clinical scenario

    A 19 year old man attends the emergency department having been assaulted in a night club. He has sustained an isolated head injury with no loss of consciousness and is fully alert and orientated. He has CSF rhinorrhoea secondary to base of skull fracture. You wonder whether the administration of antibiotics will reduce the chances of meningitis developing.

    Three part question

    In [adults with isolated base of skull fractures] does [the administration of antibiotics] reduce [the incidence of meningitis]?

    Search strategy

    Medline 1966–03/00 using the OVID interface. [{exp skull fractures OR skull fracture$.mp} OR ({exp fractures OR fracture$.mp} AND {exp skull OR] AND { OR} AND {exp antibiotics OR antibiotic$.mp}.

    Search outcome

    Altogether 27 papers were found of which 25 irrelevant or of insufficient quality for inclusion. The remaining two meta-analyses are shown in table 5.

    Table 5
    Table 6


    There are two meta-analyses in this area. One is of high quality1 while the other is not.2 Whatever the quality of the meta-analysis the studies that they analyse are poor. A well designed randomised controlled trial is still needed to answer this question properly.

    Clinical bottom line

    Antibiotics have not been shown to decrease the risk of meningitis in patients with base of skull fractures with or without CSF leaks.

    Report by John Butler, Specialist Registrar Search checked by Simon Carley, Specialist Registrar


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