*3.8.1 Antibiotics*

The treatment scheme should include third-generation cephalosporins, along with metronidazole due to oral bacteria contamination. This association of antibiotics has many advantages: it covers the spectrum of gram-positive bacteria encountered in ENT practice and also anaerobic bacteria and penetrates the blood–brain barrier [39].

These should be administered for at least 48 hours during nasal packing but better for 5–7 days including surgery and up to 14 days in cases with nasal CSF leaks. Meropenem or carbapenems after discussing with the neurosurgeon in cases with brain lesions or following local treatment protocols are also associated [40].
