The value of
antibiotic prophylaxis in patients with
Cerebrospinal Fluid Leakage (CSF) is debatable. The aim of this study was to determine the value of prophylactic
antibiotics in these patients. The study population comprised 253 patients with definite CSF leaks, of whom 106 received adequate
antibiotic prophylaxis (Group A) and 109 were not treated with
antibiotics (Group B). Thirty-eight patients were excluded from the analysis because they received
antibiotics for reasons other than the CSF leakage. The two groups were closely matched for age, sex, type of CSF
fistula, site, and duration of CSF leakage and presence or absence of
skull fractures, but there were more patients with facial fractures and
pneumocephalus in those who were treated with
antibiotics. The first week
meningitis rate was 6.6 and 9.17% in the treated and untreated groups, respectively, while the annual risk of
meningitis was 7.6% in the treated and 11.9% in the untreated group. However, these differences did not reach significance (P > 0.05). The survival curves of
meningitis-free survival were similar in the two groups, particularly during the first 4 weeks during which
antibiotics were given (Log Rank test, p > 0.05). Furthermore, there were more cases of Gram-negative
infection and of partially-treated
meningitis in the treated group. Although this was a retrospective, non-randomized study, it confirms the conclusions of previous smaller series, that prophylactic
antibiotics do not significantly reduce the risk of
meningitis in these patients. It is ethically justifiable to withhold
antibiotic prophylaxis in patients with CSF fistulae until a prospective controlled double blind trial has settled the question.