Sandbox brain abscess

brain abscess

Brain Abscess

▸ Primary source

▸ Contiguous source

▸ Post-traumatic

▸ Post-surgical

▸ metastatic or cryptogenic

▸ Immunocompromised

Primary Source
Preferred Regimen
▸ [[[Cefotaxime]] 2 gm IV q4h OR ▸ Ceftriaxone 2 gm IV q12h
PLUS
▸ Metronidazole 7.5 mg/kg q6h OR 5 mg/kg IV q12h
Alternative Regimen
▸ Penicllin G 3-4 million units IV q4h
PLUS
▸ Metronidazole 7.5 mg/kg q6h OR 15 mg/kg IV q12h

Contiguous source
Preferred Regimen
▸ *Metronidazole 500 mg/kg q8h*
PLUS
▸ [[[Cefotaxime]] 2 g IV q6h OR ▸ Piperacillin/Tazobactam 4.5 g IV q6h^†

Post-surgical
Preferred Regimen
▸ Linezolid 600 mg IV q12h OR ▸ Vancomycin 15 mg/kg loading dose or 10-15 mg/kg q6h followed by 40-60 mg/kg/24 hourly continuously infusion^‡
PLUS
▸ *Rifampin 10 mg/kg qd*
PLUS
▸ Meropenem 1.5 g q6h or 2 g q8h OR ▸ Piperacillin/Tazobactam 4.5 g q6h

metastatic or cryptogenic
Preferred Regimen
▸ *Cefataxime 2 g IV q6h*
PLUS OR NOT
▸ Metronidazole 500 mg q8h OR Ampicillin/Sulbactam 100/50 mg/kg q6h

Immunocompromised
Preferred Regimen(for minimum of 6 wks after resolution of signs)
▸ Pyrimethamine 200 mg po qd then 75 mg/day po
PLUS
▸ *Sulfadiazine: 1 gm po q6h if <60 kg, 1.5 gm po q6h if 60 kg*
PLUS
▸ *Folinic acid 10–25 mg po qd*
Suppression therapy
▸ Sulfadiazine: 2-4 g po q6-12h PLUS ▸ Pyrimethamine 25-50 mg po qd PLUS ▸ Folinic acid 10–25 mg po qd
OR
▸ TMP-SMX 5/25 mg/kg po or IV q12h for 30 days
Alternative Regimen
▸ Pyrimethamine 200 mg po qd then 75 mg/day po
▸ *Folinic acid 10–25 mg po qd*