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* Septic thrombosis of cavernous or dural venous sinus (suppurative intracranial thrombophlebitis)
* Septic thrombosis of cavernous or dural venous sinus
:* Empiric antimicrobial therapy<ref>{{Cite journal| doi = 10.1161/STR.0b013e31820a8364| issn = 1524-4628| volume = 42| issue = 4| pages = 1158–1192| last1 = Saposnik| first1 = Gustavo| last2 = Barinagarrementeria| first2 = Fernando| last3 = Brown| first3 = Robert D.| last4 = Bushnell| first4 = Cheryl D.| last5 = Cucchiara| first5 = Brett| last6 = Cushman| first6 = Mary| last7 = deVeber| first7 = Gabrielle| last8 = Ferro| first8 = Jose M.| last9 = Tsai| first9 = Fong Y.| last10 = American Heart Association Stroke Council and the Council on Epidemiology and Prevention| title = Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association| journal = Stroke; a Journal of Cerebral Circulation| date = 2011-04| pmid = 21293023}}</ref><ref>{{Cite journal| issn = 0003-9926| volume = 161| issue = 22| pages = 2671–2676| last1 = Ebright| first1 = J. R.| last2 = Pace| first2 = M. T.| last3 = Niazi| first3 = A. F.| title = Septic thrombosis of the cavernous sinuses| journal = Archives of Internal Medicine| date = 2001-12-10| pmid = 11732931}}</ref>
:* '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1161/STR.0b013e31820a8364| issn = 1524-4628| volume = 42| issue = 4| pages = 1158–1192| last1 = Saposnik| first1 = Gustavo| last2 = Barinagarrementeria| first2 = Fernando| last3 = Brown| first3 = Robert D.| last4 = Bushnell| first4 = Cheryl D.| last5 = Cucchiara| first5 = Brett| last6 = Cushman| first6 = Mary| last7 = deVeber| first7 = Gabrielle| last8 = Ferro| first8 = Jose M.| last9 = Tsai| first9 = Fong Y.| last10 = American Heart Association Stroke Council and the Council on Epidemiology and Prevention| title = Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association| journal = Stroke; a Journal of Cerebral Circulation| date = 2011-04| pmid = 21293023}}</ref><ref>{{Cite journal| issn = 0003-9926| volume = 161| issue = 22| pages = 2671–2676| last1 = Ebright| first1 = J. R.| last2 = Pace| first2 = M. T.| last3 = Niazi| first3 = A. F.| title = Septic thrombosis of the cavernous sinuses| journal = Archives of Internal Medicine| date = 2001-12-10| pmid = 11732931}}</ref>
::* Preferred regimen:  
::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h) {{and}} ([[Ceftriaxone]] 2 g IV q12h or [[Cefotaxime]] 8–12 g/day IV q4–6h) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h
::: Note (1): [[Vancomycin]] 30–45 mg/kg IV q8–12h could be substituted for nafcillin or oxacillin if the risk of MRSA is high.
::: Note (2): The optimal duration of therapy remains unclear.  A 3– to 4–week course of treatment is usually recommended.


:* Specific considerations
::* '''Cavernous sinus'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg IV q8–12h {{and}} ([[Ceftriaxone]] 2 g IV q12h or [[Cefotaxime]] 8–12 g/day IV q4–6h) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h
:::: Note: [[Daptomycin]] 8–12 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV q12h could be considered for patients unable to tolerate vancomycin.
::* '''Lateral sinus'''
:::* Preferred regimen: [[Cefepime]] 2 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8h {{and}} [[Vancomycin]] 15-20 IV mg/kg
:::* Alternative regimen: [[Meropenem]] 1-2 g IV q8h {{and}} [[Linezolid]] 600 mg IV q12h
::* '''Superior sagittal sinus'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{and}} [[Vancomycin]] 15–20 mg/kg {{and}} [[Dexamethasone]]
:::* Alternative regimen: [[Meropenem]] 1–2 g IV q8h {{and}} [[Vancomycin]] 15–20 mg/kg {{and}} [[Dexamethasone]]


:* Pathogen-directed antimicrobial therapy
:* Pathogen-directed antimicrobial therapy

Latest revision as of 06:17, 8 June 2015

  • Septic thrombosis of cavernous or dural venous sinus
  • Empiric antimicrobial therapy[1][2]
Note (1): Vancomycin 30–45 mg/kg IV q8–12h could be substituted for nafcillin or oxacillin if the risk of MRSA is high.
Note (2): The optimal duration of therapy remains unclear. A 3– to 4–week course of treatment is usually recommended.
  • Specific considerations
  • Cavernous sinus
Note: Daptomycin 8–12 mg/kg IV q24h OR Linezolid 600 mg IV q12h could be considered for patients unable to tolerate vancomycin.
  • Lateral sinus
  • Superior sagittal sinus
  • Pathogen-directed antimicrobial therapy
  • Staphylococcus aureus, methicillin-resistant (MRSA)[3]
  • Preferred regimen: Vancomycin 15–20 mg/kg/dose IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin.
  1. Saposnik, Gustavo; Barinagarrementeria, Fernando; Brown, Robert D.; Bushnell, Cheryl D.; Cucchiara, Brett; Cushman, Mary; deVeber, Gabrielle; Ferro, Jose M.; Tsai, Fong Y.; American Heart Association Stroke Council and the Council on Epidemiology and Prevention (2011-04). "Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association". Stroke; a Journal of Cerebral Circulation. 42 (4): 1158–1192. doi:10.1161/STR.0b013e31820a8364. ISSN 1524-4628. PMID 21293023. Check date values in: |date= (help)
  2. Ebright, J. R.; Pace, M. T.; Niazi, A. F. (2001-12-10). "Septic thrombosis of the cavernous sinuses". Archives of Internal Medicine. 161 (22): 2671–2676. ISSN 0003-9926. PMID 11732931.
  3. Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.