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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 skull.mp)] AND {base.mp OR basilar.mp} 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.
Comment
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