Sandbox brain abscess: Difference between revisions

	Abscess Main Page
	Brain abscess Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Brain abscess from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Sandbox brain abscess On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sandbox brain abscess All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sandbox brain abscess
CDC on Sandbox brain abscess
Sandbox brain abscess in the news
Blogs on Sandbox brain abscess
Directions to Hospitals Treating Brain abscess
Risk calculators and risk factors for Sandbox brain abscess

VisualWikitext

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 7: / Line 7: @@
 ==Antimicrobial Therapy – Empiric Therapy==
+{{rx|Preferred regimen}}
-=====Preferred regimen=====
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}}
+* [[Metronidazole]] 30 mg/kg/day q6h
+</li>
-=====Alternative regimen=====
+{{rx|Alternative regimen}}
-{{abx|Meropenem 6 g/day q8h}}
+* [[Meropenem]] 6 g/day q8h
+</li>
-====Transplant recipients====
+{{rx|Transplant recipients}}
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}} {{and}} {{abx|Voriconazole 8 mg/kg/day q12h}} {{and}} {{abx|TMP-SMZ 10–20 mg/kg/day q6–12h|Sulfadiazine 4–6 g/day q6h}}
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
+* [[Metronidazole]] 30 mg/kg/day q6h {{and}}
-====Patients with HIV/AIDS====
+* [[Voriconazole]] 8 mg/kg/day q12h {{and}}
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}} {{and}} {{abx|Sulfadiazine 4–6 g/day q6h}} {{and}} {{abx|Pyrimethamine 25–100 mg/day qd}}
+* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
+</li>
-====''Staphylococcus aureus'' coverage====
+{{rx|Patients with HIV/AIDS}}
-{{abx|Vancomycin 30–45 mg/kg/day q8–12h}}
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
+* [[Sulfadiazine]] 4–6 g/day q6h {{and}}
-====''Mycobacterium tuberculosis'' coverage====
+* [[Pyrimethamine]] 25–100 mg/day qd
-{{abx|Vancomycin 30–45 mg/kg/day q8–12h}} {{and}} {{abx|Isoniazid 300 mg qd}} {{and}} {{abx|Rifampin 600 mg qd}} {{and}} {{abx|Pyrazinamide 15–30 mg qd}} {{and}} {{abx|Ethambutol 15 mg/kg/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}}
-====''Actinomyces''====
+* [[Penicillin G]] 24 MU q4h
-{{abx|Penicillin G 24 MU q4h}}
+</li>
+{{rx|Bacteroides fragilis}}
-====''Bacteroides fragilis''====
+* [[Metronidazole]] 30 mg/kg/day q6h
-{{abx|Metronidazole 30 mg/kg/day q6h}}
+</li>
+{{rx|Enterobacteriaceae}}
-====''Enterobacteriaceae''====
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}}
+</li>
+{{rx|Fusobacterium}}
-====''Fusobacterium''====
+* [[Metronidazole]] 30 mg/kg/day q6h
-{{abx|Metronidazole 30 mg/kg/day q6h}}
+</li>
+{{rx|Haemophilus}}
-====''Haemophilus''====
+* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}}
+</li>
+{{rx|Listeria monocytogenes}}
-====''Listeria monocytogenes''====
+* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h
-{{abx|Ampicillin 12 g/day q4h|Penicillin G 24 MU q4h}}
+</li>
+{{rx|Nocardia}}
-====''Nocardia''====
+* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
-{{abx|TMP-SMZ 10–20 mg/kg/day q6–12h|Sulfadiazine 4–6 g/day q6h}}
+</li>
+{{rx|Prevotella melaninogenica}}
-====''Prevotella melaninogenica''====
+* [[Metronidazole]] 30 mg/kg/day q6h
-{{abx|Metronidazole 30 mg/kg/day q6h}}
+</li>
+{{rx|Pseudomonas aeruginosa}}
-====''Pseudomonas aeruginosa''====
+* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
-{{abx|Ceftazidime 6 g/day q8h|Cefepime 6 g/day q8h}}
+</li>
+{{rx|Methicillin-sensitive Staphylococcus aureus}}
-====Methicillin-Sensitive ''Staphylococcus aureus''====
+* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h
-{{abx|Nafcillin 12 g/day q4h|Oxacillin 12 g/day q4h}}
+</li>
+{{rx|Methicillin-resistant Staphylococcus aureus}}
-====Methicillin-resistant ''Staphylococcus aureus''====
+* [[Vancomycin]] 30–45 mg/kg/day q8–12h
-{{abx|Vancomycin 30–45 mg/kg/day q8–12h}}
+</li>
+{{rx|Streptococcus anginosus and other streptococci}}
-====''Streptococcus anginosus'' and other ''Streptococci''====
+* [[Penicillin G]] 24 MU q4h
-{{abx|Penicillin G 24 MU q4h}}
+</li>
+{{rx|Aspergillus}}
-====''Aspergillus''====
+* [[Voriconazole]] 8 mg/kg/day q12h
-{{abx|Voriconazole 8 mg/kg/day q12h}}
+</li>
+{{rx|Candida}}
-====''Candida''====
+* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
-{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}}
+</li>
+{{rx|Cryptococcus neoformans}}
-====''Cryptococcus neoformans''====
+* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
-{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}}
+</li>
+{{rx|Mucorales}}
-====''Mucorales''====
+* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
-{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}}
+</li>
+{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
-====''Pseudallescheria boydii (Scedosporium apiospermum)''====
+* [[Voriconazole]] 8 mg/kg/day q12h
-{{abx|Voriconazole 8 mg/kg/day q12h}}
+</li>
+{{rx|Toxoplasma gondii}}
-====''Toxoplasma gondii''====
+* [[Sulfadiazine]] 4–6 g/day q6h {{and}}
-{{abx|Sulfadiazine 4–6 g/day q6h}} {{and}} {{abx|Pyrimethamine 25–100 mg/day qd}}
+* [[Pyrimethamine]] 25–100 mg/day qd
+</li>
 ==References==
@@ Line 87: / Line 97: @@
 [[Category:Disease]]
 [[Category:Neurology]]
-[[Category:Infectious disease]]
 [[Category:Neurosurgery]]