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| ==Overview== | | ==Overview== |
| Treatment of brain abscess requires a multidisciplinary approach to lower [[intracranial pressure]], delineate extent of infection, evacuate [[purulent]] materials, administer appropriate [[antibiotics]], and obtain tissue specimens.
| | The treatment of brain abscess includes prompt administration of antimicrobial therapy upon suspicion and occasionally drainage to reduce the mass effect. Empiric antimicrobial therapy among otherwise healthy individuals includes [[metronidazole]] and either [[cefotaxime]] or [[ceftriaxone]]. Patients with co-morbidities may require alternative antimicrobial therapies. Administration of steroid therapy is generally not recommended and is only indicated among patients who have brain abscesses with mass effect. |
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| ==Treatment== | | ==Medical Therapy== |
| Initial treatment includes lowering the [[intracranial pressure]] and administering empiric [[antibiotic]]s. Stereotactic needle biopsy can be performed to obtain tissues for cultures.
| | *Prompt administration of antimicrobial therapy is indicated among all patients with brain abscesses. |
| | *Neurosurgery should always be consulted upon diagnosis. The decision of whether to surgically drain, aspirate, or simply administer antimicrobial therapy depends on the number of abscesses, their size, and their location. To learn more about indications of surgical vs. aspiration drainage, click [[Brain abscess surgery|'''here''']]. |
| | *Stereotactic needle biopsy can be performed to obtain tissues for cultures. |
| | *A follow-up head CT scan or MRI is usually indicated at 2-4 weeks of follow-up. The improvement on imaging is often delayed compared to clinical improvement. |
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| A brain abscesses greater than 3 cm in diameter should be considered for surgical drainage if accessible, with an exception of tuberculous brain abscess which is treated with anti-tuberculous agents.
| | ==Antimicrobial Regimen== |
| | {{ID-Brain abscess}} |
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| |
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| *Antibiotics: Brain abscesses are usually polymicrobial, with the most common bugs being microaerophilic ''[[streptococci]]'' (viridans) and anaerobic bacteria (bacteroides, anaerobic strep and [[fusobacterium]]).
| | ==Other Pharmacologic Agents== |
| :* ''[[S. aureus]]'', and enterobacteriacae are also seen.
| | ===Steroids=== |
| :* Bugs associated with [[trauma]] include ''[[S. aureus]]'' and ''[[clostridium]]'' sp.
| | *Administration of glucocorticoids is generally not recommended. However, glucorticoids are only indicated when the brain abscess has a mass effect, as suggested by findings on imaging. |
| :* Empiric Rx usually starts with high-dose PCN (10 – 20 million units / d), [[metronidazole]], +/- a 3rd gen [[cephalosporin]].
| | *Steroid regimen: |
| ::* Even if the abscess is associated with a dental procedure and other organisms are considered ([[actinomyces]] sp.) they generally respond to the above Rx.
| | :*Preferred regimen: [[Dexamethasone]] 10 mg IV loading dose {{then}} 4 mg q6h until the mass effect is no longer observed on imaging. |
| ::* If extending from an [[otitis]], empiric Rx should also cover ''[[pseudomonas]]'' and enterobacteriacaea.
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| ::* If hematogenously spread, coverage depends on the original bug.
| |
| *The penetration of abx into an abscess does not necessarily equate with their penetration into the [[CSF]] (the blood-brain barrier is not the same as the blood-CSF barrier).
| |
| :* Drugs like [[vancomycin]], which have poor [[CSF]] levels (<10% of serum) have been shown to have good abscess levels (90% of serum).
| |
| * Most patients are treated parenterally for at least 8w.
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| :* Some authors also recommend an additional 2 – 3 month course of oral abx to clear up any ‘residual’ infection and to prevent relapses.
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| :* One study actually suggests that, when combined with surgical excision, 3w may be adequate.
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| :* Other studies have reported good outcomes with abx alone in patients with small lesions (<2cm), in well vascularized areas (cortex), who were poor surgical candidates.
| |
| * There have not been any studies reporting benefit from intra-thecal or intra-abscess abx.
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| * There seems to be consensus on obtaining q 2 – 4w f/u [[CT]]/[[MRI]] scans to document resolution.
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| | |
| ==== Adjuvants ==== | |
| :* Although steroids have not been studies in well-designed trials, many authors use them in patients with elevated ICP.
| |
| :* Some animal studies suggest interference with granulation tissue formation and bacterial clearance.
| |
| :* [[Anticonvulsant]]s are recommended prophylactically for the 1st 3m, though the data supporting this is lacking.
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| | |
| ==Brain Abscess Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Principles And Practice Of Infectious Disease''<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
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| ===Bacteira Brain Abscess===
| |
| | |
| <font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
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| {|
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Empiric Therapy'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Otitis media or mastoiditis'''
| |
| </font>
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| </div>
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| | |
| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Sinusitis '''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Dental infection'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Penetrating trauma'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table04b" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Postsurgical'''
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| </font>
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| </div>
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| | |
| <div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Pulmonary resource'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Bacterial endocarditis'''
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| </font>
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| </div>
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| | |
| <div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Congenital heart disease'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
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| <font color="#FFF">
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| ▸ '''Unknown'''
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| </font>
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| </div>
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Otitis media or mastoiditis}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Sinusitis}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''<sup>†</sup>
| |
| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Dental infection}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin]] 4 million U IV q4h'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
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| |-
| |
| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Penetrating trauma}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>‡</sup>'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04b" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Postsurgical}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>‡</sup>'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Lung abscess, empyema, bronchiectasis}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin]] 4 million U IV q4h'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg q8h'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfonamide]] 500 mg q8h<sup>§</sup>'''''
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacterial endocarditis}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>#</sup>'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Congenital heart disease}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Unknown}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg q8h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''<sup>‡</sup>
| |
| |-
| |
| |}
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| |}
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| |}
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| <small><small><small><small>†:Add vancomycin when infection caused by methicillin-resistant Staphylococcus aureus is suspected.</small></small></small></small>
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| <small><small><small><small>‡:Use ceftazidime or cefepime as the cephalosporin if Pseudomonas aeruginosa is suspected.</small></small></small></small>
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| <small><small><small><small>§:Trimethoprim-sulfamethoxazole; include if a Nocardia spp. is suspected.</small></small></small></small>
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| | |
| ==Brain Absecss Special Pathogen Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Principles And Practice Of Infectious Disease''<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
| |
| | |
| <font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
| |
| | |
| {|
| |
| | valign=top |
| |
| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
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| '''Bacteria Brain Abscess'''
| |
| </font>
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| </div>
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| | |
| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Actinomyces spp.'''
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| </font>
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| </div>
| |
| | |
| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Bacteroides fragilis'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Enterobacteriaceae'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Fusobacterium spp.'''
| |
| </font>
| |
| </div>
| |
| <div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| | |
| <font color="#FFF">
| |
| ▸ '''Haemophilus spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Listeria monocytogenes'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Mycobacterium tuberculosis'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Nocardia spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Prevotella melaninogenica'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Pseudomonas aeruginosa'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Staphylococcus aureus'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Streptococcus anginosus'''
| |
| </font>
| |
| </div>
| |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Actinomyces spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 2 gm IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacteroides fragilis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacteroides fragilis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g PO q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Fusobacterium spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Haemophilus spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Listeria monocytogenes}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>†<sup>'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Mycobacterium tuberculosis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Isoniazid]] 300 mg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 600 mg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrazinamide ]] 15-30 mg/kg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS OR NOT
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ethambutol]] 15 mg/kg PO qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Nocardia spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg IV q6-12h''''''<BR>''OR''<BR>▸ '''''[[Sulfadiazine]] 1-1.5 g PO q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Minocycline]]'''''<BR>''OR''<BR>▸ '''''[[Imipenem]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g PO q8h'''''<BR>''OR''<BR>▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Amikacin]] 5 mg/kg IV q8h(monitor peak and trough serum concentrations)'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Prevotella melaninogenica}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''<BR>''OR''<BR>▸ '''''[[Cefotaxime]] 2 g IV q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Pseudomonas aeruginosa<sup>†<sup>}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Staphylococcus aureus;Methicillin-sensitive}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Oxacillin]] 1.5-2 g IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h<small>*</small>'''''
| |
| |-
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Staphylococcus aureus;Methicillin-resistant}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h<small>*</small>'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-sulfamethoxazole]] 10-20 mg/kg IV q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;" | |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Streptococcus anginosus (milleri) group, other streptococci}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h<small>*</small>'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
| | |
| ===Fungal Brain Abscess===
| |
| | |
| <font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
| |
| | |
| {|
| |
| | valign=top |
| |
| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
| |
| '''Fungal Brain Abscess'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Aspergillus spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Candida spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Cryptococcus neoformans'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Mucorales'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Scedosporium spp.'''
| |
| </font>
| |
| </div>
| |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Aspergillus spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] Load with 6 mg/kg IV q12h for two doses then 4 mg/kg q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B deoxycholate]]'''''<BR>''OR''<BR>▸ '''''[[Liposomal Amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''<BR>''OR''<BR>▸ '''''[[Itraconazole]] 400 mg IV q12h<sup>¶</sup>'''''<BR>''OR''<BR>▸ '''''[[Posaconazole]] 200-400 mg q6-12h<sup>¶</sup>'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Candida spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B deoxycholate]] 0.6-1.0 mg/kg IV qd<sup>♠</sup>'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluconazole]] 400-800 mg IV qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background:#FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Cryptococcus neoformans}}
| |
| |-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Amphotericin B deoxycholate]] 0.6-1.0 mg/kg IV qd<sup>♠</sup>'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Flucytosine]] 25 mg/kg PO q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Fluconazole]] 400-800 mg IV qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background:#FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Mucorales}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Amphotericin B deoxycholate]] 0.6-1.0 mg/kg IV qd<sup>♠</sup>'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg PO qd'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Posaconazole]] 200-400 mg q6-12h<sup>¶</sup>'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background:#FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Scedosporium spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] Load with 6 mg/kg IV q12h for two doses then 4 mg/kg q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen<sup>¶</sup>'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 400 mg IV q12h '''''<BR>''OR''<BR>▸ '''''[[Posaconazole]] 200-400 mg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
| | |
| ===Protozoa Brain Abscess===
| |
| | |
| {|
| |
| |-
| |
| | valign=top |
| |
| {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
| |
| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Toxoplasma gondii]]}}''
| |
| |-
| |
| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrimethamine]] 25-75 mg PO qd'''''
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Sulfadiazine]] 1-1.5 g PO q6h
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrimethamine]] 25-75 mg PO qd'''''<BR>''PLUS''<BR>▸ '''''[[Clindamycin]] 25-75 mg IV qd'''''
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | OR
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg PO q6-12h'''''
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | OR
| |
| |-
| |
| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrimethamine]] 25-75 mg PO qd'''''<BR>''PLUS''<BR>▸ '''''[[Azithromycin]] 1200-1500 mg IV qd'''''<BR>''OR''<BR>▸ '''''[[Clarithromycin]]'''''<BR>''OR''<BR>▸ '''''[[Atovaquone]] 750 mg PO 6h'''''<BR>''OR''<BR>▸ '''''[[Dapsone]] 100 mg PO qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| <small><small><small><small>†:Addition of an aminoglycoside should be considered.</small></small></small></small>
| |
| <small><small><small><small>¶:Consider for use in salvage therapy in nonresponding patients or in patients intolerant of amphotericin B–based therapies.</small></small></small></small>
| |
| | |
| <small><small><small><small>♠:Dosages up to 1.5 mg/kg/day may be used for aspergillosis or mucormycosis.</small></small></small></small>
| |
| <small><small><small><small>*:Adjust dosage based on trough serum concentration.</small></small></small></small>
| |
|
| |
|
| ==References== | | ==References== |
| {{Reflist|2}} | | {{reflist|2}} |
|
| |
|
| [[Category:Disease]] | | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| | [[Category:Neurosurgery]] |
| | [[Category:Emergency medicine]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| [[Category:Neurosurgery]]
| |
| [[Category:Needs overview]]
| |
|
| |
|
| |
| {{WH}}
| |
| {{WS}}
| |