Efficacy of Antibiotic Prophylaxis in Preventing Infections Following Frontal Sinus Fracture Management: A Retrospective Analysis

Frontal sinus fractures (FSF) can lead to detrimental intracranial infections, yet there is variability in the literature regarding the efficacy of antibiotic prophylaxis. This study aims to provide guidance on the role of prophylactic antibiotics in mitigating infection following FSF. A retrospective cohort study was conducted from January 2018 to December 2022 comparing the incidence of infection between patients managed with versus without antibiotics. Patients with FSF diagnosed by CT scan and at least 18 years old were included. Our primary outcome was the incidence of infection following FSF. Of 201 patients, 26 (12.9%) had a dural tear or cerebrospinal fluid leak (CSF). Patients managed with antibiotics were significantly more likely to have a dural tear or CSF leak [25 (15.4%), 1 (2.6%), P=0.032], and none of these patients developed an infection. A total of 6 (3%) patients developed infection, including 4 meningitis cases and 2 sinusitis cases. Infections occurred in 5 of 162 patients (3.1%) who received antibiotics, compared with 1 infection (2.6%) in the 39 patients without antibiotic prophylaxis, with no statistically significant difference (P=1.0). The most common prophylactic antibiotic among patients who developed infection was IV cefazolin. The majority of fractures (149, 74%) were managed conservatively, including all patients who developed infections. Although further randomized controlled trials are needed to better define the role of antibiotic prophylaxis in preventing infections, antibiotics may not be necessary for all FSF patients. In the subset of patients with CSF leak, the absence of infection might indicate the protective effects of antibiotics.