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Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks

Published online by Cambridge University Press:  14 July 2014

J Rimmer ,
C Belk ,
V J Lund ,
A Swift  and
P White
J Rimmer*
Affiliation:
Department of Otolaryngology, Royal National Throat, Nose and Ear Hospital, London, UK
C Belk
Affiliation:
Department of Otolaryngology, Royal National Throat, Nose and Ear Hospital, London, UK
V J Lund
Affiliation:
Department of Otolaryngology, Royal National Throat, Nose and Ear Hospital, London, UK Ear Institute, University College London, UK
A Swift
Affiliation:
Department of Otolaryngology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
P White
Affiliation:
Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK
*
Address for correspondence: Ms Joanne Rimmer, Department of Otolaryngology, Royal National Throat, Nose and Ear Hospital, 330 Gray's Inn Road, London WC1X 8DA, UK Fax: 020 7883 9480 E-mail: [email protected]
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Abstract

Objective:

There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.

Method:

A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed.

Results:

Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent).

Conclusion:

There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.

Keywords

Cerebrospinal Fluid RhinorrheaSkull BaseMeningitisVaccinationAntibiotic Prophylaxis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 7 , July 2014 , pp. 626 - 629
Copyright
Copyright © JLO (1984) Limited 2014 

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References

1Daudia, A, Biswas, D, Jones, NS. Risk of meningitis with cerebrospinal fluid rhinorrhoea. Ann Otol Rhinol Laryngol 2007;116:902–5Google Scholar
2Bernal-Sprekelsen, M, Alobid, I, Mullol, J, Trobat, F, Tomas-Barberan, M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005;43:277–81Google Scholar
3Lund, VJ, Stammberger, H, Nicolai, P, Castelnuovo, P, Beal, T, Beham, A et al. European position paper on endoscopic management of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010;22:1–143Google Scholar
4Psaltis, AJ, Schlosser, RJ, Banks, CA, Yawn, J, Soler, ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2012;147:196–203Google Scholar
5Eljamel, MS, Foy, PM. Non-traumatic CSF fistulae: clinical history and management. Br J Neurosurg 1991;5:275–9CrossRefGoogle ScholarPubMed
6Moralee, SJ. Should prophylactic antibiotics be used in the management of cerebrospinal fluid rhinorrhoea following endoscopic sinus surgery? A review of the literature. Clin Otolaryngol Allied Sci 1995;20:100–2Google Scholar
7Ratilal, BO, Costa, J, Sampaio, C, Pappamikail, L. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev 2011;(8):CD004884CrossRefGoogle ScholarPubMed
8Brodie, HA. Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae. Arch Otolaryngol Head Neck Surg 1997;123:749–52CrossRefGoogle ScholarPubMed
9Cameron, C, Pebody, R. Introduction of pneumococcal conjugate vaccine to the UK childhood immunisation programme, and changes to the meningitis C and Hib schedules. Euro Surveill 2006;11:eE060302.4Google Scholar
10Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012;61:816–19Google Scholar
11Pebody, RG, Leino, T, Nohynek, H, Hellenbrand, W, Salmaso, S, Ruutu, P. Pneumococcal vaccination policy in Europe. Euro Surveill 2005;10:174–8CrossRefGoogle ScholarPubMed
12British National Formulary. Section 14: Immunological products and vaccines. In: http://www.bnf.org [12 June 2014]Google Scholar
13Siegrist, C-A. Vaccine immunology. In: Plotkin, SA, Orenstein, WA, Offit, PA, eds. Vaccines. Oxford: Elsevier Health Sciences, 2008;23Google Scholar