Should prophylactic antibiotics be used in the management of cerebrospinal fluid rhinorrhoea following endoscopic sinus surgery? A review of the literature.

This review article investigates whether prophylactic antibiotics should be used in the management of cerebrospinal fluid rhinorrhoea following endoscopic sinus surgery. A medline database was used to retrieve all English articles from 1970 to the present, cross-indexing cerebrospinal rhinorrhoea, antibiotics and endoscopic sinus surgery. All relevant articles retrieved were reviewed together with their bibliographies. The use of prophylactic antibiotics is neither recommended nor condemned by evidence of efficacy. However, their use is cautioned against by evidence of a subsequent change in nasopharyngeal flora to potentially more invasive organisms. The review concludes that, at present, it is usually justifiable to withhold prophylactic antibiotics and to observe for the symptoms and signs of meningitis instituting antibiotic therapy when this complication develops.