Sandbox brain abscess: Difference between revisions

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Latest revision as of 18:41, 18 September 2017

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

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

References

@@ Line 6: / Line 6: @@
 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==
+{{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>
+==Antimicrobial Therapy – Pathogen-Based Therapy==
+{{rx|Actinomyces}}
+* [[Penicillin G]] 24 MU q4h
+</li>
+{{rx|Bacteroides fragilis}}
+* [[Metronidazole]] 30 mg/kg/day q6h
+</li>
+{{rx|Enterobacteriaceae}}
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
+</li>
+{{rx|Fusobacterium}}
+* [[Metronidazole]] 30 mg/kg/day q6h
+</li>
+{{rx|Haemophilus}}
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
+</li>
+{{rx|Listeria monocytogenes}}
+* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h
+</li>
+{{rx|Nocardia}}
+* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
+</li>
+{{rx|Prevotella melaninogenica}}
+* [[Metronidazole]] 30 mg/kg/day q6h
+</li>
+{{rx|Pseudomonas aeruginosa}}
+* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
+</li>
+{{rx|Methicillin-sensitive Staphylococcus aureus}}
+* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h
+</li>
+{{rx|Methicillin-resistant Staphylococcus aureus}}
+* [[Vancomycin]] 30–45 mg/kg/day q8–12h
+</li>
+{{rx|Streptococcus anginosus and other streptococci}}
+* [[Penicillin G]] 24 MU q4h
+</li>
+{{rx|Aspergillus}}
+* [[Voriconazole]] 8 mg/kg/day q12h
+</li>
+{{rx|Candida}}
+* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
+</li>
+{{rx|Cryptococcus neoformans}}
+* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
+</li>
+{{rx|Mucorales}}
+* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
+</li>
+{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
+* [[Voriconazole]] 8 mg/kg/day q12h
+</li>
+{{rx|Toxoplasma gondii}}
+* [[Sulfadiazine]] 4–6 g/day q6h {{and}}
+* [[Pyrimethamine]] 25–100 mg/day qd
+</li>
 ==References==
@@ Line 14: / Line 97: @@
 [[Category:Disease]]
 [[Category:Neurology]]
-[[Category:Infectious disease]]
 [[Category:Neurosurgery]]