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097. Antibiotic Prophylaxis for Open Pediatric Skull Fractures- A Systematic Review

Authors: Lekhaj C. Daggubati, MD

Introduction:
Skull fractures are a common pathology in the pediatric population and open skull fractures are especially controversial. The management can vary between surgical and conservative management based on location and dural status. However, the use of prophylactic antibiotics is largely unclear even with numerous studies. We perform a systematic review to summarize the current data on prophylactic antibiotics for a pediatric skull fracture.Methods: We performed a systematic review of "skull fractures," "antibiotics," and "pediatric/ child*" in Pubmed, Embase, and Cochrane databases. Each was evaluated for relevance and adequate data. The primary outcome was the comparison of infectious risk with and without prophylactic antibiotics.
Results:
A total of 113 articles were screened before 29 full-texts were screened further for relevance. A total of 8 ranging between 1978-2021 were included in the final review. A total of 459 patients were collated and ranged from 1 month to 18 years. 295 (64%) children received prophylactic antibiotics and 164 (36%) children did not get prophylactic antibiotics. Of these, 1.7% (n=8) of children with prophylaxis and 2% (n=9) of children without prophylaxis had meningitis. There was no significant difference between the two cohorts (p= 0.131). The most common prophylaxis was with cephalosporins (cefazolin and ceftriaxone). None of the 8 articles made recommendations to continue prophylactic antibiotics in pediatric open skull fractures.
Conclusion:
The systematic review did not show a significant benefit to prophylactic antibiotics in the setting of a pediatric skull fracture and at current, the use of antibiotics prophylaxis is inconclusive.