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Antimicrobial prophylaxis for fractured base of skull in children
1Trauma Unit, Red Cross War Memorial Children's Hospital, Rondebosch, Republic of South Africa.
Insights
This study reviewed 50 children with fractured base of skull. Antibiotic prophylaxis did not significantly alter the low incidence of infective complications like pneumococcal meningitis.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Infectious Disease Epidemiology
Background:
- Fractures of the base of the skull (FBS) are severe head injuries in children.
- Infective complications, particularly meningitis, are a significant concern following FBS.
- The role of antibiotic prophylaxis in preventing these complications remains debated.
Purpose of the Study:
- To review the outcomes of children treated for FBS over a 10-year period.
- To evaluate the incidence of infective complications in children with FBS, with and without antibiotic prophylaxis.
- To assess the effectiveness of antibiotic prophylaxis in preventing meningitis.
Main Methods:
- Retrospective review of 50 pediatric patients diagnosed with FBS over 10 years.
- Categorization of patients based on whether they received antibiotic prophylaxis (23 patients) or not (25 patients).
- Analysis of infective complications, focusing on cases of meningitis.
Main Results:
- Two patients died early due to severe head injury, unrelated to sepsis.
- One case of pneumococcal meningitis occurred in the prophylaxis group and one in the non-prophylaxis group.
- Both meningitis cases were successfully treated, indicating a low overall incidence of infective complications.
Conclusions:
- Antibiotic prophylaxis did not demonstrate a significant impact on reducing infective complications in children with FBS.
- The incidence of meningitis following FBS is low, regardless of prophylactic antibiotic use.
- Larger patient series are needed to draw statistically significant conclusions on this rare condition.
Abstract:
The details are reviewed of 50 children who were treated over a 10-year period with clinical signs of fractured base of skull. Two patients died early without signs of sepsis--due to the severity of their head injuries. Of the remainder, 23 received antibiotic prophylaxis and 25 did not. One patient from each of these groups developed pneumococcal meningitis, and they were successfully treated. Our results correlate well with those previously published, confirming the low incidence of infective complications with or without prophylaxis. The need to assemble a large enough series to make statistically significant conclusions regarding this infrequent condition is highlighted throughout the literature, which is reviewed here.