- Design
- Systematic review and meta-analysis of 14 observational studies
- Population
- 7,981 patients undergoing endoscopic endonasal skull-base surgery
- Primary outcome
- Postoperative meningitis by prophylaxis duration
- Effect
- 1.24% (≤1 day), 1.20% (1–3 days), 2.12% (>3 days); P=0.76 for difference
This systematic review pooled 14 studies of 7,981 patients undergoing endoscopic endonasal skull-base surgery with a single prophylactic antibiotic. Postoperative meningitis occurred in 1.38% overall (95% CI 0.92 to 2.08%), with substantial heterogeneity (I² = 65.8%).
By duration, incidence was 1.24% with ultra-short prophylaxis (one day or less), 1.20% with one to three days and 2.12% with more than three days. The difference was not significant, and duration was not associated with meningitis on meta-regression. A higher proportion of intraoperative CSF leak was associated with more meningitis.
Prolonged antibiotics after skull-base surgery, often continued while nasal packing stays in, are common practice and a stewardship target. These data, though observational and study-level, give no sign that longer courses protect. Risk appears to sit with the operation, particularly CSF leak, not with how long the antibiotic runs.
- Consider limiting prophylaxis after endonasal skull-base surgery to about 24 hours.
- Longer courses showed no lower meningitis rate in pooled data.
- Focus surveillance on patients with intraoperative CSF leak, where meningitis was more common.
- Agree a written duration with the neurosurgical team rather than continuing until packing is removed.
Why it matters
It removes the main argument for multi-day prophylaxis in a procedure where it is routinely prolonged.
Don't overread it
These are pooled observational cohorts with high heterogeneity, not a randomised comparison of durations.
The statistics, in plain English
The overlapping confidence intervals and a subgroup P value of 0.76 mean the duration groups could not be told apart. I² of 65.8% means the studies differed considerably, so the pooled rate is an average across varied practice.
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