Sandbox brain abscess: Difference between revisions
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Treatment of brain abscess requires a multidisciplinary approach to delineate extent of infection, plan stereotactic trajectory, aspirate [[purulent]] materials, lower [[intracranial pressure]], identify causative pathogen, and administer appropriate [[antibiotics]]. | Treatment of brain abscess requires a multidisciplinary approach to delineate extent of infection, plan stereotactic trajectory, aspirate [[purulent]] materials, lower [[intracranial pressure]], identify causative pathogen, and administer appropriate [[antibiotics]]. | ||
==Antimicrobial Therapy – Empiric Therapy== | |||
{{rx|Preferred regimen}} | |||
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} | |||
* [[Metronidazole]] 30 mg/kg/day q6h | |||
</li> | |||
{{rx|Alternative regimen}} | |||
* [[Meropenem]] 6 g/day q8h | |||
</li> | |||
{{rx|Transplant recipients}} | |||
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} | |||
* [[Metronidazole]] 30 mg/kg/day q6h {{and}} | |||
* [[Voriconazole]] 8 mg/kg/day q12h {{and}} | |||
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h | |||
</li> | |||
{{rx|Patients with HIV/AIDS}} | |||
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} | |||
* [[Sulfadiazine]] 4–6 g/day q6h {{and}} | |||
* [[Pyrimethamine]] 25–100 mg/day qd | |||
</li> | |||
{{rx|Staphylococcus aureus coverage}} | |||
* [[Vancomycin]] 30–45 mg/kg/day q8–12h | |||
</li> | |||
{{rx|Mycobacterium tuberculosis coverage}} | |||
* [[Isoniazid]] 300 mg qd {{and}} | |||
* [[Rifampin]] 600 mg qd {{and}} | |||
* [[Pyrazinamide]] 15–30 mg qd {{and}} | |||
* [[Ethambutol]] 15 mg/kg/day qd | |||
</li> | |||
==Antimicrobial Therapy – Pathogen-Based Therapy== | |||
{{rx|Actinomyces}} | |||
* [[Penicillin G]] 24 MU q4h | |||
</li> | |||
{{rx|Bacteroides fragilis}} | |||
* [[Metronidazole]] 30 mg/kg/day q6h | |||
</li> | |||
{{rx|Enterobacteriaceae}} | |||
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h | |||
</li> | |||
{{rx|Fusobacterium}} | |||
* [[Metronidazole]] 30 mg/kg/day q6h | |||
</li> | |||
{{rx|Haemophilus}} | |||
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h | |||
</li> | |||
{{rx|Listeria monocytogenes}} | |||
* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h | |||
</li> | |||
{{rx|Nocardia}} | |||
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h | |||
</li> | |||
{{rx|Prevotella melaninogenica}} | |||
* [[Metronidazole]] 30 mg/kg/day q6h | |||
</li> | |||
{{rx|Pseudomonas aeruginosa}} | |||
* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h | |||
</li> | |||
{{rx|Methicillin-sensitive Staphylococcus aureus}} | |||
* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h | |||
</li> | |||
{{rx|Methicillin-resistant Staphylococcus aureus}} | |||
* [[Vancomycin]] 30–45 mg/kg/day q8–12h | |||
</li> | |||
{{rx|Streptococcus anginosus and other streptococci}} | |||
* [[Penicillin G]] 24 MU q4h | |||
</li> | |||
{{rx|Aspergillus}} | |||
* [[Voriconazole]] 8 mg/kg/day q12h | |||
</li> | |||
{{rx|Candida}} | |||
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | |||
</li> | |||
{{rx|Cryptococcus neoformans}} | |||
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | |||
</li> | |||
{{rx|Mucorales}} | |||
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | |||
</li> | |||
{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}} | |||
* [[Voriconazole]] 8 mg/kg/day q12h | |||
</li> | |||
{{rx|Toxoplasma gondii}} | |||
* [[Sulfadiazine]] 4–6 g/day q6h {{and}} | |||
* [[Pyrimethamine]] 25–100 mg/day qd | |||
</li> | |||
==References== | ==References== | ||
| Line 14: | Line 97: | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Neurosurgery]] | [[Category:Neurosurgery]] | ||
Latest revision as of 18:41, 18 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Brain abscess Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Sandbox brain abscess On the Web |
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American Roentgen Ray Society Images of Sandbox brain abscess |
Overview
Treatment of brain abscess requires a multidisciplinary approach to delineate extent of infection, plan stereotactic trajectory, aspirate purulent materials, lower intracranial pressure, identify causative pathogen, and administer appropriate antibiotics.
Antimicrobial Therapy – Empiric Therapy
- Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND
- Metronidazole 30 mg/kg/day q6h
- Meropenem 6 g/day q8h
- Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND
- Metronidazole 30 mg/kg/day q6h AND
- Voriconazole 8 mg/kg/day q12h AND
- TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h
- Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND
- Sulfadiazine 4–6 g/day q6h AND
- Pyrimethamine 25–100 mg/day qd
- Vancomycin 30–45 mg/kg/day q8–12h
- Isoniazid 300 mg qd AND
- Rifampin 600 mg qd AND
- Pyrazinamide 15–30 mg qd AND
- Ethambutol 15 mg/kg/day qd
Antimicrobial Therapy – Pathogen-Based Therapy
- Penicillin G 24 MU q4h
- Metronidazole 30 mg/kg/day q6h
- Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
- Metronidazole 30 mg/kg/day q6h
- Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
- Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h
- TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h
- Metronidazole 30 mg/kg/day q6h
- Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h
- Vancomycin 30–45 mg/kg/day q8–12h
- Penicillin G 24 MU q4h
- Voriconazole 8 mg/kg/day q12h
- Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Voriconazole 8 mg/kg/day q12h
- Sulfadiazine 4–6 g/day q6h AND
- Pyrimethamine 25–100 mg/day qd