Forty-six cases of basilar skull fractures in children were reviewed to 
determine the incidence of CNS infection following injury and the possible value 
of antimicrobial chemoprophylaxis. The clinical course of the children who were 
treated with antibiotics was compared with that of patients who received no 
antimicrobial therapy. Included in the study were patients with hemotympanum 
alone or with hemotympanum plus additional clinical or roentgenographic signs of 
basilar skull fracture; patients with tympanic membrane perforation without 
otorrhea but with blood in the auditory canal; and children with either otorrhea 
or rhinorrhea. Acute, delayed, or recurrent infection of the CNS did not develop 
in any of the patients. This study is the first of its kind presented in 
children. It would seem on the basis of the present series that the systematic 
use of antibiotic prophylaxis in children with hemotympanum following basilar 
skull fractures is unwarranted and that children with other signs of basilar 
skull fractures may have an equally small risk of meningitis following injury.