Sandbox brain abscess

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Treatment of brain abscess requires a multidisciplinary approach to delineate extent of infection, plan stereotactic trajectory, aspirate purulent materials, lower intracranial pressure, identify causative pathogen, and administer appropriate antibiotics.

Antimicrobial Therapy – Empiric Therapy

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND
• Metronidazole 30 mg/kg/day q6h

• Meropenem 6 g/day q8h

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND
• Metronidazole 30 mg/kg/day q6h AND
• Voriconazole 8 mg/kg/day q12h AND
• TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND
• Sulfadiazine 4–6 g/day q6h AND
• Pyrimethamine 25–100 mg/day qd

• Vancomycin 30–45 mg/kg/day q8–12h

• Isoniazid 300 mg qd AND
• Rifampin 600 mg qd AND
• Pyrazinamide 15–30 mg qd AND
• Ethambutol 15 mg/kg/day qd

Antimicrobial Therapy – Pathogen-Based Therapy

• Penicillin G 24 MU q4h

• Metronidazole 30 mg/kg/day q6h

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

• Metronidazole 30 mg/kg/day q6h

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

• Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h

• TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h

• Metronidazole 30 mg/kg/day q6h

• Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h

• Nafcillin 12 g/day q4h OR Oxacillin 12 g/day q4h

• Vancomycin 30–45 mg/kg/day q8–12h

• Penicillin G 24 MU q4h

• Voriconazole 8 mg/kg/day q12h

• Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

• Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

• Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

• Voriconazole 8 mg/kg/day q12h

• Sulfadiazine 4–6 g/day q6h AND
• Pyrimethamine 25–100 mg/day qd