Sandbox brain abscess: Difference between revisions

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==Overview==
==Overview==
Treatment of brain abscess requires a multidisciplinary approach to lower [[intracranial pressure]], delineate extent of infection, evacuate [[purulent]] materials, administer appropriate [[antibiotics]], and obtain tissue specimens.
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]].


==Treatment==
==Antimicrobial Therapy – Empiric Therapy==
Initial treatment includes lowering the [[intracranial pressure]] and administering empiric [[antibiotic]]s. Stereotactic needle biopsy can be performed to obtain tissues for cultures.
{{rx|Preferred regimen}}
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} 
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Alternative regimen}}
* [[Meropenem]] 6 g/day q8h
</li>
{{rx|Transplant recipients}}
* [[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
</li>
{{rx|Patients with HIV/AIDS}}
* [[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
</li>
{{rx|Staphylococcus aureus coverage}}
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</li>
{{rx|Mycobacterium tuberculosis coverage}}
* [[Isoniazid]] 300 mg qd {{and}} 
* [[Rifampin]] 600 mg qd {{and}} 
* [[Pyrazinamide]] 15–30 mg qd {{and}} 
* [[Ethambutol]] 15 mg/kg/day qd
</li>


A brain abscess greater than 3 cm in diameter should be considered for surgical drainage if accessible, with an exception of tuberculous brain abscess which is treated with anti-tuberculous agents.
==Antimicrobial Therapy – Pathogen-Based Therapy==
 
{{rx|Actinomyces}}
*Antibiotics: Brain abscesses are usually polymicrobial, with the most common bugs being microaerophilic ''[[streptococci]]'' (viridans) and anaerobic bacteria (bacteroides, anaerobic strep and [[fusobacterium]]).
* [[Penicillin G]] 24 MU q4h
:* ''[[S. aureus]]'', and enterobacteriacae are also seen.
</li>
:* Bugs associated with [[trauma]] include ''[[S. aureus]]'' and ''[[clostridium]]'' sp.
{{rx|Bacteroides fragilis}}
:* Empiric Rx usually starts with high-dose PCN (10 – 20 million units / d), [[metronidazole]], +/- a 3rd gen [[cephalosporin]].
* [[Metronidazole]] 30 mg/kg/day q6h
::* Even if the abscess is associated with a dental procedure and other organisms are considered ([[actinomyces]] sp.) they generally respond to the above Rx.
</li>
::* If extending from an [[otitis]], empiric Rx should also cover ''[[pseudomonas]]'' and enterobacteriacaea.
{{rx|Enterobacteriaceae}}
::* If hematogenously spread, coverage depends on the original bug.
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
*The penetration of abx into an abscess does not necessarily equate with their penetration into the [[CSF]] (the blood-brain barrier is not the same as the blood-CSF barrier).
</li>
:* Drugs like [[vancomycin]], which have poor [[CSF]] levels (<10% of serum) have been shown to have good abscess levels (90% of serum).
{{rx|Fusobacterium}}
* Most patients are treated parenterally for at least 8w.
* [[Metronidazole]] 30 mg/kg/day q6h
:* Some authors also recommend an additional 2 – 3 month course of oral abx to clear up any ‘residual’ infection and to prevent relapses.
</li>
:* One study actually suggests that, when combined with surgical excision, 3w may be adequate.
{{rx|Haemophilus}}
:* Other studies have reported good outcomes with abx alone in patients with small lesions (<2cm), in well vascularized areas (cortex), who were poor surgical candidates.
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
* There have not been any studies reporting benefit from intra-thecal or intra-abscess abx.
</li>
* There seems to be consensus on obtaining q 2 – 4w f/u [[CT]]/[[MRI]] scans to document resolution.
{{rx|Listeria monocytogenes}}
 
* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h
==== Adjuvants ====
</li>
:* Although steroids have not been studies in well-designed trials, many authors use them in patients with elevated ICP.
{{rx|Nocardia}}
:* Some animal studies suggest interference with granulation tissue formation and bacterial clearance.
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
:* [[Anticonvulsant]]s are recommended prophylactically for the 1st 3m, though the data supporting this is lacking.
</li>
 
{{rx|Prevotella melaninogenica}}
==Brain Abscess Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Principles And Practice Of Infectious Disease''<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
* [[Metronidazole]] 30 mg/kg/day q6h
 
</li>
===Bacteira Brain Abscess===
{{rx|Pseudomonas aeruginosa}}
 
* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
<font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
</li>
 
{{rx|Methicillin-sensitive Staphylococcus aureus}}
{|
* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h
| valign=top |
</li>
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
{{rx|Methicillin-resistant Staphylococcus aureus}}
<font color="#FFF">
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
'''Empiric Therapy'''
</li>
</font>
{{rx|Streptococcus anginosus and other streptococci}}
</div>
* [[Penicillin G]] 24 MU q4h
 
</li>
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
{{rx|Aspergillus}}
<font color="#FFF">
* [[Voriconazole]] 8 mg/kg/day q12h
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Otitis media or mastoiditis'''
</li>
</font>
{{rx|Candida}}
</div>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
 
</li>
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
{{rx|Cryptococcus neoformans}}
<font color="#FFF">
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Sinusitis '''
</li>
</font>
{{rx|Mucorales}}
</div>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
 
</li>
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
<font color="#FFF">
* [[Voriconazole]] 8 mg/kg/day q12h
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Dental infection'''
</li>
</font>
{{rx|Toxoplasma gondii}}
</div>
* [[Sulfadiazine]] 4–6 g/day q6h {{and}} 
 
* [[Pyrimethamine]] 25–100 mg/day qd
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
</li>
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Penetrating trauma'''
</font>
</div>
 
<div class="mw-customtoggle-table04b" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Postsurgical'''
</font>
</div>
 
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pulmonary resource'''
</font>
</div>
 
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Bacterial endocarditis'''
</font>
</div>
 
<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Congenital heart disease'''
</font>
</div>
 
<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Unknown'''
</font>
</div>
 
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Otitis media or mastoiditis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Sinusitis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''<sup>†</sup>
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Dental infection}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin]] 4 million U IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Penetrating trauma}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>‡</sup>'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04b" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Postsurgical}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>‡</sup>'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Lung abscess, empyema, bronchiectasis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin]] 4 million U IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfonamide]] 500 mg q8h<sup>§</sup>'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacterial endocarditis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>#</sup>'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Congenital heart disease}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Unknown}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''<sup>‡</sup>
|-
|}
|}
|}
 
 
 
 
<small><small><small><small>†:Add vancomycin when infection caused by methicillin-resistant Staphylococcus aureus is suspected.</small></small></small></small>
<small><small><small><small>‡:Use ceftazidime or cefepime as the cephalosporin if Pseudomonas aeruginosa is suspected.</small></small></small></small>
<small><small><small><small>§:Trimethoprim-sulfamethoxazole; include if a Nocardia spp. is suspected.</small></small></small></small>
 
==Brain Absecss Special Pathogen Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Principles And Practice Of Infectious Disease''<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
 
<font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
 
{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Bacteria Brain Abscess'''
</font>
</div>
 
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Actinomyces spp.'''
</font>
</div>
 
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Bacteroides fragilis'''
</font>
</div>
 
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Enterobacteriaceae'''
</font>
</div>
 
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Fusobacterium spp.'''
</font>
</div>
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
 
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Haemophilus spp.'''
</font>
</div>
 
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Listeria monocytogenes'''
</font>
</div>
 
<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Mycobacterium tuberculosis'''
</font>
</div>
 
<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Nocardia spp.'''
</font>
</div>
 
<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Prevotella melaninogenica'''
</font>
</div>
 
<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pseudomonas aeruginosa'''
</font>
</div>
 
<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Staphylococcus aureus'''
</font>
</div>
 
<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Streptococcus anginosus'''
</font>
</div>
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Actinomyces spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 2 gm IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacteroides fragilis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacteroides fragilis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g PO q8h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Fusobacterium spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Haemophilus spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>
▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Listeria monocytogenes}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>†<sup>'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Mycobacterium tuberculosis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Isoniazid]] 300 mg PO qd'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 600 mg PO qd'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrazinamide ]] 15-30 mg/kg PO qd'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS OR NOT
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ethambutol]] 15 mg/kg PO qd'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Nocardia spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg IV q6-12h''''''<BR>''OR''<BR>▸ '''''[[Sulfadiazine]] 1-1.5 g PO q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Minocycline]]'''''<BR>''OR''<BR>▸ '''''[[Imipenem]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g PO q8h'''''<BR>''OR''<BR>▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Amikacin]] 5 mg/kg IV q8h(monitor peak and trough serum concentrations)'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Prevotella melaninogenica}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''<BR>''OR''<BR>▸ '''''[[Cefotaxime]] 2 g IV q8h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Pseudomonas aeruginosa<sup>†<sup>}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Staphylococcus aureus;Methicillin-sensitive}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Oxacillin]] 1.5-2 g IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h<small>*</small>'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Staphylococcus aureus;Methicillin-resistant}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h<small>*</small>'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-sulfamethoxazole]] 10-20 mg/kg IV q6-12h'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Streptococcus anginosus (milleri) group, other streptococci}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h<small>*</small>'''''
|-
|}
|}
|}
 
===Fungal Brain Abscess===
 
<font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
 
{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Fungal Brain Abscess'''
</font>
</div>
 
<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Aspergillus spp.'''
</font>
</div>
 
<div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Candida spp.'''
</font>
</div>
 
<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Cryptococcus neoformans'''
</font>
</div>
 
<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Mucorales'''
</font>
</div>
 
<div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Scedosporium spp.'''
</font>
</div>
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Aspergillus spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] Load with 6 mg/kg IV q12h for two doses then 4 mg/kg q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B deoxycholate]]'''''<BR>''OR''<BR>▸ '''''[[Liposomal Amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''<BR>''OR''<BR>▸ '''''[[Itraconazole]] 400 mg IV  q12h<sup>¶</sup>'''''<BR>''OR''<BR>▸ '''''[[Posaconazole]] 200-400 mg q6-12h<sup>¶</sup>'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Candida spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B deoxycholate]] 0.6-1.0 mg/kg IV qd<sup>♠</sup>'''''<BR>''OR''<BR>
▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluconazole]] 400-800 mg IV qd'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background:#FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Cryptococcus neoformans}}
|-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Amphotericin B deoxycholate]] 0.6-1.0 mg/kg IV qd<sup>♠</sup>'''''<BR>''OR''<BR>
▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Flucytosine]] 25 mg/kg PO q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Fluconazole]] 400-800 mg IV qd'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background:#FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Mucorales}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Amphotericin B deoxycholate]] 0.6-1.0 mg/kg IV qd<sup>♠</sup>'''''<BR>''OR''<BR>
▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Posaconazole]] 200-400 mg q6-12h<sup>¶</sup>'''''
|-
|}
|}
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background:#FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Scedosporium spp.}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] Load with 6 mg/kg IV q12h for two doses then 4 mg/kg q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen<sup>¶</sup>'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 400 mg IV  q12h '''''<BR>''OR''<BR>▸ '''''[[Posaconazole]] 200-400 mg q6-12h'''''
|-
|}
|}
|}
 
===Protozoa Brain Abscess===
 
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Toxoplasma gondii]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrimethamine]] 25-75 mg PO qd'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Sulfadiazine]] 1-1.5 g PO q6h
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrimethamine]] 25-75 mg PO qd'''''<BR>''PLUS''<BR>▸ '''''[[Clindamycin]] 25-75 mg IV qd'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | OR
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg PO q6-12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | OR
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrimethamine]] 25-75 mg PO qd'''''<BR>''PLUS''<BR>▸ '''''[[Azithromycin]] 1200-1500 mg IV qd'''''<BR>''OR''<BR>▸ '''''[[Clarithromycin]]'''''<BR>''OR''<BR>▸ '''''[[Atovaquone]] 750 mg PO 6h'''''<BR>''OR''<BR>▸ '''''[[Dapsone]] 100 mg PO qd'''''
|-
|}
|}
 
<small><small><small><small>†:Addition of an aminoglycoside should be considered.</small></small></small></small>
<small><small><small><small>¶:Consider for use in salvage therapy in nonresponding patients or in patients intolerant of amphotericin B–based therapies.</small></small></small></small>
 
<small><small><small><small>♠:Dosages up to 1.5 mg/kg/day may be used for aspergillosis or mucormycosis.</small></small></small></small>
<small><small><small><small>*:Adjust dosage based on trough serum concentration.</small></small></small></small>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Infectious disease]]
 
[[Category:Neurosurgery]]
[[Category:Neurosurgery]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 18:41, 18 September 2017

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

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