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Skull and facial fractures resulting from neurotrauma

Content version
U-304.2
Updated
10/20/2025 - 12:51

Recommendations

≥ 18 years

Indications: open/contaminated fractures and for a fracture of the frontal sinus with involvement of the posterior wall
Dosage Remarks
cefazolin IV 2000 mg

single dose
≥ 18 years

Indications: Penetrating skull or spinal fractures
Dosage Remarks
cefazolin IV 2000 mg three times daily for 1 to 4 days

If SDD > 3 days, then no (additional) antibiotic prophylaxis

Comments

Based on the national Dutch guideline [1], as well as a published Cochrane review [2], the prophylactic use of antibiotics in patients with a basal skull fracture (or closed traumatic brain injury) is not recommended, as it does not reduce the risk of bacterial meningitis.

At Radboudumc the policy is as above. No antibiotic prophylaxis is indicated for post-traumatic cerebrospinal fluid leakage, pneumocephalus, or closed non-operative orbital or other facial fractures