**5. Management**

In patients who have a traumatic leak and normal CSF pressure, conservative treatment consists of bed rest with head of bed elevation and lumbar drainage of CSF for 5–10 days. With conservative management, there is a reported risk ranging from 7 to 30% of ascending meningitis. The incidence of spontaneous resolution with conservative management is reported to be 70%.

The general consensus among practicing otolaryngologist is that antibiotics should not be used for conservative management unless there is a very large defect with comminuted bone of the skull base as a simple CSF leak carries a 7% infection rate (meningitis, intracranial abscess, cellulitis abscess, and osteomyelitis) and prophylactic antibiotics have not been shown to decrease the risk of infection. After endoscopic repair, antibiotics are generally recommended for 24–48 hours including Cefazolin (1 gm q8), Vancomycin (1 gm q12), or Clindamycin (600 mg q8). This is done to cover possible contamination at the time of surgery in a non-sterile field with concomitant sealing of the sterile to non-sterile flushing of an active leak [4, 5].
