Template:ID-Epidural abscess: Difference between revisions

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:*1.2 '''Pathogen-directed antimicrobial therapy'''
:*1.2 '''Pathogen-directed antimicrobial therapy'''
::*1.2.1 '''Penicillin-susceptible Staphylococcus aureus or Streptococcus'''
::*1.2.1 '''Penicillin-susceptible ''Staphylococcus aureus'' or ''Streptococcus'''''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks


::*1.2.2 '''Methicillin-susceptible Staphylococcus aureus or Streptococcus'''
::*1.2.2 '''Methicillin-susceptible ''Staphylococcus aureus'' or ''Streptococcus'''''
:::* Preferred regimen (1): [[Cefazolin]] 2 g IV q8h for 2–4 weeks {{then}} PO to complete 6–8 weeks  
:::* Preferred regimen (1): [[Cefazolin]] 2 g IV q8h for 2–4 weeks {{then}} PO to complete 6–8 weeks  


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:::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
:::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks


::*1.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::*1.2.3 '''Methicillin-resistant ''Staphylococcus aureus'' (MRSA)'''
:::* Preferred regimen: [[Vancomycin]] loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
:::* Preferred regimen: [[Vancomycin]] loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 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
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:::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
:::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.


::*1.2.4 '''Streptococcus'''
::*1.2.4 '''''Streptococcus'''''
:::* Preferred regimen (1): [[Penicillin G]] 3–4 MU IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks   
:::* Preferred regimen (1): [[Penicillin G]] 3–4 MU IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks   


:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks


::*1.2.5 '''Enterococcus'''
::*1.2.5 '''''Enterococcus'''''
:::* Preferred regimen (1): [[Penicillin G]] 3–4 MU IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks  
:::* Preferred regimen (1): [[Penicillin G]] 3–4 MU IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks  


:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks


::*1.2.6 '''Enterobacteriaceae'''
::*1.2.6 '''''Enterobacteriaceae'''''
:::* Preferred regimen (1): [[Ceftriaxone]] 1–2 g IV q12h for 2–4 weeks {{then}} PO to complete 6–8 weeks   
:::* Preferred regimen (1): [[Ceftriaxone]] 1–2 g IV q12h for 2–4 weeks {{then}} PO to complete 6–8 weeks   


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:::* Preferred regimen: [[Metronidazole]] 500 mg IV q6h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen: [[Metronidazole]] 500 mg IV q6h for 2–4 weeks {{then}} PO to complete 6–8 weeks


::*1.2.9 '''Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)'''
::*1.2.9 '''''Staphylococcus'', Gram-negative bacteria, and anaerobes (mixed infection)'''
:::* Preferred regimen (1): [[Ampicillin-Sulbactam]] 3 g IV q6h for 2–4 weeks {{then}} PO to complete 6–8 weeks  
:::* Preferred regimen (1): [[Ampicillin-Sulbactam]] 3 g IV q6h for 2–4 weeks {{then}} PO to complete 6–8 weeks  


Latest revision as of 16:38, 6 October 2015

  • 1.1 Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks AND Ceftriaxone 2 g IV q24h for 2–4 weeks, then PO to complete 6–8 weeks
  • Note (1): Decompressive laminectomy in conjunction with long-term antibiotic therapy tailored to culture results is required.
  • Note (2): For critically ill patients, a loading dose of Vancomycin 20–25 mg/kg may be considered.
  • 1.2 Pathogen-directed antimicrobial therapy
  • 1.2.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen (1): Cefazolin 2 g IV q8h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (3): Oxacillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
  • 1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 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 in adult patients.
  • 1.2.4 Streptococcus
  • Preferred regimen (1): Penicillin G 3–4 MU IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.5 Enterococcus
  • Preferred regimen (1): Penicillin G 3–4 MU IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.6 Enterobacteriaceae
  • Preferred regimen (1): Ceftriaxone 1–2 g IV q12h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Cefotaxime 2 g IV q6–8h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.7 Gram-negative bacteria
  • Preferred regimen (1): Ceftazidime 2 g IV q8h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Cefepime 2 g IV q12h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (1): Ciprofloxacin 400 mg IV q12h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (2): Levofloxacin 750 mg IV q24h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (3): Moxifloxacin 400 mg IV q24h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.8 Anaerobes
  • Preferred regimen: Metronidazole 500 mg IV q6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.9 Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)
  • Preferred regimen (1): Ampicillin-Sulbactam 3 g IV q6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q4–6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (1): Imipenem 500–1000 mg IV q6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (2): Meropenem 1–2 g IV q8h for 2–4 weeks THEN PO to complete 6–8 weeks
  1. ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  3. ↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
  4. ↑ 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.
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