Systematic review of the effectiveness of perioperative prophylactic antibiotics for skull base surgeries

Background: Perioperative antibiotics are commonly used in endoscopic skull base surgeries as prophylaxis for infectious complications, e.g., meningitis. The role of perioperative prophylactic antibiotics in endoscopic sinus surgery is unclear, and the routine use of prophylactic antibiotics in endoscopic skull base surgery is also highly debated. Currently, there is no formal recommendation for perioperative antibiotic use in skull base surgery, and regimens vary greatly from one institution to the next. Objective: To assess perioperative antibiotics as prophylaxis against infectious complications in patients who underwent endoscopic skull base surgery. Data Sources: PubMed, Ovid EMBASE, and the Cochrane Library. Methods: A systematic review that examined perioperative antibiotic use in endoscopic skull base and craniofacial surgeries was conducted. Inclusion criteria were prospective or retrospective study design and clinical trials related to the use of antibiotics within 30 days of skull base surgery. End points included infectious complications such as (1) meningitis and (2) sinusitis. Results: A total of 2543 articles were identified by the initial search, and 5 articles met inclusion criteria. The five eligible trials were all observational and involved different types of skull base surgical procedures and antibiotic regimens. Conclusions: Despite institutional variability in antibiotic regimens, meningitis rarely occurs after skull base procedures and seems to be encountered most frequently in open craniofacial surgeries. A systematic review revealed a limited number of published studies, all observational in study design, which precluded a formal meta-analysis. A novel large-scale randomized-controlled clinical trial is needed to evaluate antibiotic selection and need in endoscopic skull base surgery.