Meningitis is one of the most serious complications following basilar skull fracture. Previous studies addressing the role of antibiotics for the prevention of meningitis after basilar skull fractures have not clearly delineated the role of prophylactic antibiotics. The objective of this meta-analysis was to determine if prophylactic antibiotic use after basilar skull fracture prevented meningitis. We performed a formal systematic review of previously published studies after a computarized search using MEDLINE database. Fourteen studies were identified. We reviewed 12 of the 14 studies that met our criteria for inclusion. Trial design and quality was assessed using a predetermined protocol by two independent investigators. A third investigator was used as a referee for disagreement between the two investigators. Each paper was analyzed individually and assessed for statistical power. Subsequently, all studies were combined for pooled statistical analysis. A total of 1258 patients with diagnosis of basilar skull fracture were analyzed, 731 patients received antibiotics and 527 patients did not receive antibiotics. Using a two-tailed Mantel-Haenzel test, the p-value for the common odds rate was 0.088 (OR 1.55 with a 95% CI 0.94-2.57), which indicates that prophylaxis is not beneficial for prevention of meningitis in these patients. We also performed analysis to determine if prophylactic antibiotics were useful in prevention of meningitis when basilar skull fracture was associated with CSF rhinorrea or otorrhea. These data also suggest that the use of prophylactic antibiotics inpatients after basilar skull fractures with CSF leak have no benefit in preventing bacterial meningitis.
