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A Meta-analysis

Hilary A. Brodie, MD, PhD

Arch Otolaryngol Head Neck Surg. 1997;123(7):749-752.

Abstract
Objective
To determine the efficacy of prophylactic antibiotics in the treatment of posttraumatic cerebrospinal fluid fistulae.

Design
Meta-analysis with literature review.

Methods
A MEDLINE search was performed to obtain all the reports pertaining to posttraumatic cerebrospinal fluid fistulae between 1970 and 1995. All the series that provided data specifying whether prophylactic antibiotics were provided and the incidence of meningitis were included in the analysis.

Results
The findings of 6 studies, involving 324 patients, were analyzed. In these studies, 237 received prophylactic antibiotics and 87 did not. Only 6 of the 237 patients who received prophylactic antibiotics developed meningitis, yielding an incidence of 2.5%. Nine (10%) of the 87 patients who did not receive prophylactic antibiotics developed meningitis. The incidence of meningitis was significantly lower in the patients who received prophylactic antibiotics than in those who did not receive prophylaxis (Fisher exact test, P=.006).

Conclusions
Individually, each of the studies included in this analysis demonstrated no significant difference in the incidence of meningitis with prophylactic antibiotic therapy. The reason for this is that inadequate numbers of patients were available at each institution. Pooling the data from the past 25 years revealed a statistically significant reduction in the incidence of meningitis with prophylactic antibiotic therapy.

Arch Otolaryngol Head Neck Surg. 1997;123:749-752

Author Affiliations
From the Department of Otolaryngology, University of California, Davis, School of Medicine, Sacramento.

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