Basilar skull fracture (7% to 15.8% of all skull fractures) places the central nervous system in contact with bacteria from the nose and throat and may be associated with cerebrospinal fluid leakage (occurring in 2% to 20.8% of patients). Blood or watery discharge from nose or ears, bruising behind the ear or around the eyes, hearing loss, inability to perceive odours or facial asymmetry may lead physicians to the diagnosis of basilar skull fracture. Patients with a basilar skull fracture may develop meningitis and some doctors give antibiotics in an attempt to reduce this risk.
This review examined five randomised controlled trials, comprising a total of 208 participants, that compared those who received preventive antibiotic therapy and developed meningitis with those who did not receive antibiotics and developed meningitis. The available data did not support the use of prophylactic antibiotics, as there is no proven benefit of such therapy. There was a possible adverse effect of increasing susceptibility to infection with more pathogenic organisms. The review authors call for research to address this question, as there are too few studies available on this subject and they have overall design shortcomings and small combined numbers of participants studied.