Open Skull Fractures
VBMC TRAUMA CARE SERVICES GUIDELINE
Open Skull Fracture Antibiotic
The incidence of meningitis occurring after head trauma ranges from 1.4
to 10.6% in patients who receive antimicrobials. However, the efficacy of
antimicrobial prophylaxis to prevent meningitis remains controversial due to
low-quality clinical data.
A recent multicenter trial evaluated infection after penetrating brain
injury5. Patients were stratified into two categories, those who
received prophylactic antibiotics for penetrating brain injury, and those who
did not. Antibiotic regimens and duration of prophylaxis was not well defined.
Infection rate was 7% in patients who received antibiotics, compared with 6% in
those who did not. The use of prophylactic antibiotics did not impact the rate
of infection in the results of this study.
Meta-analyses describing the use of prophylactic antibiotics in the
setting of basilar skull fractures failed to show a decrease in the incidence
of meningitis compared to no antibiotics. However, clinical data suggests
that the presence of a CSF leak is an additional risk factor for developing
meningitis, and patients who present with a CSF leak may benefit from
antibiotic prophylaxis.
This document is intended to serve only as a guideline based on current
review of medical literature, and not intended to replace clinical judgment,
physician/surgeon discretion, or special circumstances.
Resources:
1. Ratilal BO, Costa J,
Pappamikail, et al. Antibiotic prophylaxis for preventing meningitis in patient
with basilar skull fractures. Cochrane Database Sys Rev. 2015
Apr 28;(4): CD004884. doi: 10.1002/14651858.CD004884.pub4.
2. May AK, Fleming SB,
Carpenter RO et al. Influence of broad-spectrum antibiotic prophylaxis on
intracranial pressure monitor infections and subsequent infectious
complications in head-injured patients. Surg Infect (Larchmt) 2006; 7:409-417.
3. Villalobos T, Arango
C, Kubilis P et al. Antibiotic prophylaxis after basilar skull fractures: a
meta-analysis. Clin Infect Dis 1998; 27:364-369.
4. Yellinek S, Cohen A, Merkin V, Shelef I, Benifla M. Clinical significance of skull base fracture in patients after traumatic brain injury. J Clin Neurosci. 2016;25:111–5.