Template:ID-Subdural empyema: Difference between revisions

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::*2.3 '''Intracranial subdural empyema after cranial trauma'''
::*2.3 '''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 {{or}} [[Oxacillin]] 2 g IV q4h
:::* 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.


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::*2.6 '''Spinal subdural empyema'''
::*2.6 '''Spinal subdural empyema'''
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:::* 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.



Revision as of 18:17, 31 July 2015

  • 1. Causative pathogens
  • 1.1 More common
  • Streptococcus milleri
  • Other streptococci and enterococci
  • Aerobic Gram-negative bacilli (Haemophilus influenzae, Proteus, Escherichia coli, Pseudomonas, Klebsiella, Acinetobacter, Salmonella, Morganella, Eikenella)
  • No growth
  • 1.2 Less common
  • Streptococcus pneumoniae
  • Staphylococcus aureus, coagulase-negative staphylococci
  • Anaerobic Gram-positive cocci (Veillonella, Peptostreptococcus, others)
  • Anaerobic Gram-negative bacilli (Bacteroides, Fusobacterium, Prevotella)
  • 2. Empiric antimicrobial therapy
  • The choice of antimicrobial agent should be based on Gram stain results and directed against the likely causative microorganisms in the specific clinical setting.
  • 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.
  • 2.1 Intracranial subdural empyema with unclear source of infection
  • 2.2 Intracranial subdural empyema associated with sinusitis or otitis media
  • 2.3 Intracranial subdural empyema after cranial trauma
  • Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
  • Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • 2.4 Intracranial subdural empyema after neurosurgical procedures
  • 2.5 Intracranial subdural empyema in neonates (usually associated with meningitis)
  • 2.5.1 Infants < 1 month
  • 2.5.2 Infants 1–3 months
  • 2.5.3 Infants > 3 months
  • 2.6 Spinal subdural empyema
  • Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
  • Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 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.
  1. 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)
  2. 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)
  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.