Template:ID-Subdural empyema: Difference between revisions
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* Subdural empyema<ref>{{Cite journal| doi = 10.1016/S1473-3099(06)70688-0| issn = 1473-3099| volume = 7| issue = 1| pages = 62–67| last1 = Osborn| first1 = Melissa K.| last2 = Steinberg| first2 = James P.| title = Subdural empyema and other suppurative complications of paranasal sinusitis| journal = The Lancet. Infectious Diseases| date = 2007-01| pmid = 17182345}}</ref><ref>{{Cite journal| issn = 1092-8480| volume = 5| issue = 1| pages = 13–22| last = Greenlee| first = John E.| title = Subdural Empyema| journal = Current Treatment Options in Neurology| date = 2003-01| pmid = 12521560}}</ref> | * Subdural empyema<ref>{{Cite journal| doi = 10.1016/S1473-3099(06)70688-0| issn = 1473-3099| volume = 7| issue = 1| pages = 62–67| last1 = Osborn| first1 = Melissa K.| last2 = Steinberg| first2 = James P.| title = Subdural empyema and other suppurative complications of paranasal sinusitis| journal = The Lancet. Infectious Diseases| date = 2007-01| pmid = 17182345}}</ref><ref>{{Cite journal| issn = 1092-8480| volume = 5| issue = 1| pages = 13–22| last = Greenlee| first = John E.| title = Subdural Empyema| journal = Current Treatment Options in Neurology| date = 2003-01| pmid = 12521560}}</ref> | ||
:* | :* '''Empiric antimicrobial therapy''' | ||
::* Metronidazole is recommended if anaerobes are suspected. Metronidazole is not necessary for antianaerobic activity if Meropenem is used. | ::* Metronidazole is recommended if anaerobes are suspected. Metronidazole is not necessary for antianaerobic activity if Meropenem is used. | ||
::* For coverage of aerobic Gram-negative bacilli, empiric therapy with Cefepime, Ceftazidime, or Meropenem is appropriate. | ::* For coverage of aerobic Gram-negative bacilli, empiric therapy with Cefepime, Ceftazidime, or Meropenem is appropriate. | ||
| Line 20: | Line 8: | ||
::* Consider adjunctive medications including prophylactic anticonvulsants, corticosteroids, and mannitol if clinically indicated. | ::* Consider adjunctive medications including prophylactic anticonvulsants, corticosteroids, and mannitol if clinically indicated. | ||
::* | ::* '''Intracranial subdural empyema with unclear source of infection''' | ||
:::* 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 | :::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h for 3-4 weeks {{or}} [[Oxacillin]] 2 g IV q4h for 3-4 weeks) {{and}} ([[Ceftriaxone]] 2 g IV q12h for 3-4 weeks {{or}} [[Cefotaxime]] 8–12 g/day IV q4–6h for 3-4 weeks) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h for 3-4 weeks | ||
:::* Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | :::* Note: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | ||
::* | ::* '''Intracranial subdural empyema associated with sinusitis or otitis media''' | ||
:::* 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 | :::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h for 3-4 weeks {{or}} [[Oxacillin]] 2 g IV q4h for 3-4 weeks) {{and}} ([[Ceftriaxone]] 2 g IV q12h for 3-4 weeks {{or}} [[Cefotaxime]] 8–12 g/day IV q4–6h for 3-4 weeks) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h for 3-4 weeks | ||
:::* Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | :::* Note: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | ||
::* | ::* '''Intracranial subdural empyema after cranial trauma''' | ||
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h | :::* Preferred regimen: [[Nafcillin]] 2 g IV q4h for 3-4 weeks {{or}} [[Oxacillin]] 2 g IV q4h for 3-4 weeks | ||
:::* Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | :::* Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | ||
::* | ::* '''Intracranial subdural empyema after neurosurgical procedures''' | ||
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Ceftazidime]] 2 g IV q8h | :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 3-4 weeks {{and}} [[Ceftazidime]] 2 g IV q8h for 3-4 weeks | ||
::* | ::* '''Intracranial subdural empyema in neonates (usually associated with meningitis)''' | ||
:::* | :::* '''Infants < 1 month''' | ||
::::* Preferred regimen: [[Ampicillin]] 200 mg/kg/day IV q4h {{and}} [[Cefotaxime]] 200 mg/kg/day IV q6h | ::::* Preferred regimen: [[Ampicillin]] 200 mg/kg/day IV q4h for 3-4 weeks {{and}} [[Cefotaxime]] 200 mg/kg/day IV q6h for 3-4 weeks | ||
:::* | :::* '''Infants 1–3 months''' | ||
::::* Preferred regimen: [[Ampicillin]] 200 mg/kg/day IV q4h {{and}} ([[Cefotaxime]] 200 mg/kg/day IV q6h {{or}} [[Ceftriaxone]] 100 mg/kg/day IV q12h) | ::::* Preferred regimen: [[Ampicillin]] 200 mg/kg/day IV q4h for 3-4 weeks {{and}} ([[Cefotaxime]] 200 mg/kg/day IV q6h for 3-4 weeks {{or}} [[Ceftriaxone]] 100 mg/kg/day IV q12h for 3-4 weeks) | ||
:::* | :::* '''Infants > 3 months''' | ||
::::* Preferred regimen: [[Vancomycin]] 60 mg/kg/day IV q6h {{and}} ([[Cefotaxime]] 200 mg/kg/day IV q6h {{or}} [[Ceftriaxone]] 100 mg/kg/day IV q12h {{or}} [[Cefepime]] 150 mg/kg/day IV q8h) | ::::* Preferred regimen: [[Vancomycin]] 60 mg/kg/day IV q6h for 3-4 weeks {{and}} ([[Cefotaxime]] 200 mg/kg/day IV q6h for 3-4 weeks{{or}} [[Ceftriaxone]] 100 mg/kg/day IV q12h for 3-4 weeks {{or}} [[Cefepime]] 150 mg/kg/day IV q8h for 3-4 weeks) | ||
::* | ::* '''Spinal subdural empyema''' | ||
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h | :::* Preferred regimen: [[Nafcillin]] 2 g IV q4h for 3-4 weeks {{or}} [[Oxacillin]] 2 g IV q4h for 3-4 weeks | ||
:::* Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | :::* Note: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present. | ||
:* | :* '''Pathogen-directed antimicrobial therapy''' | ||
::* | ::* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref> | ||
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks | :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day 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 | :::* 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 | :::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h | ||
:::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin. | :::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin therapy. | ||
==References== | |||
{{reflist|2}} | |||
Latest revision as of 19:53, 6 October 2015
- Empiric antimicrobial therapy
- Metronidazole is recommended if anaerobes are suspected. Metronidazole is not necessary for antianaerobic activity if Meropenem is used.
- For coverage of aerobic Gram-negative bacilli, empiric therapy with Cefepime, Ceftazidime, or Meropenem is appropriate.
- Depending on the clinical response, parenteral antimicrobial therapy should be administered for 3 to 4 weeks after drainage. Parenteral or oral therapy is frequently continued for up to a total of 6 weeks of therapy.
- A longer course of treatment (minimum of 6–8 weeks) may be required if the patient has accompanying osteomyelitis.
- Consider adjunctive medications including prophylactic anticonvulsants, corticosteroids, and mannitol if clinically indicated.
- Intracranial subdural empyema with unclear source of infection
- Preferred regimen: (Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks) AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 8–12 g/day IV q4–6h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h for 3-4 weeks
- Note: Vancomycin 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
- Intracranial subdural empyema associated with sinusitis or otitis media
- Preferred regimen: (Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks) AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 8–12 g/day IV q4–6h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h for 3-4 weeks
- Note: Vancomycin 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
- Intracranial subdural empyema after cranial trauma
- Preferred regimen: Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks
- Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
- Intracranial subdural empyema after neurosurgical procedures
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 3-4 weeks AND Ceftazidime 2 g IV q8h for 3-4 weeks
- Intracranial subdural empyema in neonates (usually associated with meningitis)
- Infants < 1 month
- Preferred regimen: Ampicillin 200 mg/kg/day IV q4h for 3-4 weeks AND Cefotaxime 200 mg/kg/day IV q6h for 3-4 weeks
- Infants 1–3 months
- Preferred regimen: Ampicillin 200 mg/kg/day IV q4h for 3-4 weeks AND (Cefotaxime 200 mg/kg/day IV q6h for 3-4 weeks OR Ceftriaxone 100 mg/kg/day IV q12h for 3-4 weeks)
- Infants > 3 months
- Preferred regimen: Vancomycin 60 mg/kg/day IV q6h for 3-4 weeks AND (Cefotaxime 200 mg/kg/day IV q6h for 3-4 weeksOR Ceftriaxone 100 mg/kg/day IV q12h for 3-4 weeks OR Cefepime 150 mg/kg/day IV q8h for 3-4 weeks)
- Spinal subdural empyema
- Preferred regimen: Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks
- Note: Vancomycin 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
- Pathogen-directed antimicrobial therapy
- Staphylococcus aureus, methicillin-resistant (MRSA)[3]
- Preferred regimen: Vancomycin 30–45 mg/kg/day 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: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin therapy.
References
- ↑ Osborn, Melissa K.; Steinberg, James P. (2007-01). "Subdural empyema and other suppurative complications of paranasal sinusitis". The Lancet. Infectious Diseases. 7 (1): 62–67. doi:10.1016/S1473-3099(06)70688-0. ISSN 1473-3099. PMID 17182345. Check date values in:
|date=(help) - ↑ Greenlee, John E. (2003-01). "Subdural Empyema". Current Treatment Options in Neurology. 5 (1): 13–22. ISSN 1092-8480. PMID 12521560. Check date values in:
|date=(help) - ↑ 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.