Sandbox brain abscess: Difference between revisions

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==Antimicrobial Therapy – Empiric Therapy==
==Antimicrobial Therapy – Empiric Therapy==
<ul class="mw-collapsible mw-collapsed" data-expandtext="Preferred regimen" data-collapsetext="Preferred regimen">
{{rx|Preferred regimen}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} 
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Alternative regimen" data-collapsetext="Alternative regimen">
{{rx|Alternative regimen}}
<li>[[Meropenem]] 6 g/day q8h</li>
* [[Meropenem]] 6 g/day q8h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Transplant recipients" data-collapsetext="Transplant recipients">
{{rx|Transplant recipients}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} 
<li>[[Metronidazole]] 30 mg/kg/day q6h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Metronidazole]] 30 mg/kg/day q6h {{and}} 
<li>[[Voriconazole]] 8 mg/kg/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Voriconazole]] 8 mg/kg/day q12h {{and}} 
<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h <u>OR</u> [[Sulfadiazine]] 4–6 g/day q6h</li>
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Patients with HIV/AIDS" data-collapsetext="Patients with HIV/AIDS">
{{rx|Patients with HIV/AIDS}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} 
<li>[[Sulfadiazine]] 4–6 g/day q6h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Sulfadiazine]] 4–6 g/day q6h {{and}} 
<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
* [[Pyrimethamine]] 25–100 mg/day qd
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Staphylococcus aureus coverage" data-collapsetext="Staphylococcus aureus coverage">
{{rx|Staphylococcus aureus coverage}}
<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Mycobacterium tuberculosis coverage" data-collapsetext="Mycobacterium tuberculosis coverage">
{{rx|Mycobacterium tuberculosis coverage}}
<li>[[Isoniazid]] 300 mg qd<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Isoniazid]] 300 mg qd {{and}} 
<li>[[Rifampin]] 600 mg qd<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Rifampin]] 600 mg qd {{and}} 
<li>[[Pyrazinamide]] 15–30 mg qd<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Pyrazinamide]] 15–30 mg qd {{and}} 
<li>[[Ethambutol]] 15 mg/kg/day qd</li>
* [[Ethambutol]] 15 mg/kg/day qd
</ul>
</li>


==Antimicrobial Therapy – Pathogen-Based Therapy==
==Antimicrobial Therapy – Pathogen-Based Therapy==
<ul class="mw-collapsible mw-collapsed" data-expandtext="Actinomyces" data-collapsetext="Actinomyces">
{{rx|Actinomyces}}
<li>[[Penicillin G]] 24 MU q4h</li>
* [[Penicillin G]] 24 MU q4h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Bacteroides fragilis" data-collapsetext="Bacteroides fragilis">
{{rx|Bacteroides fragilis}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Enterobacteriaceae" data-collapsetext="Enterobacteriaceae">
{{rx|Enterobacteriaceae}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h</li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Fusobacterium" data-collapsetext="Fusobacterium">
{{rx|Fusobacterium}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Haemophilus" data-collapsetext="Haemophilus">
{{rx|Haemophilus}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h</li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Listeria monocytogenes" data-collapsetext="Listeria monocytogenes">
{{rx|Listeria monocytogenes}}
<li>[[Ampicillin]] 12 g/day q4h <u>OR</u> [[Penicillin G]] 24 MU q4h</li>
* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Nocardia" data-collapsetext="Nocardia">
{{rx|Nocardia}}
<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h <u>OR</u> [[Sulfadiazine]] 4–6 g/day q6h</li>
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Prevotella melaninogenica" data-collapsetext="Prevotella melaninogenica">
{{rx|Prevotella melaninogenica}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Pseudomonas aeruginosa" data-collapsetext="Pseudomonas aeruginosa">
{{rx|Pseudomonas aeruginosa}}
<li>[[Ceftazidime]] 6 g/day q8h <u>OR</u> [[Cefepime]] 6 g/day q8h</li>
* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Methicillin-sensitive Staphylococcus aureus" data-collapsetext="Methicillin-sensitive Staphylococcus aureus">
{{rx|Methicillin-sensitive Staphylococcus aureus}}
<li>[[Nafcillin]] 12 g/day q4h <u>OR</u> [[Oxacillin]] 12 g/day q4h</li>
* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Methicillin-resistant Staphylococcus aureus" data-collapsetext="Methicillin-resistant Staphylococcus aureus">
{{rx|Methicillin-resistant Staphylococcus aureus}}
<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Streptococcus anginosus and other streptococci" data-collapsetext="Streptococcus anginosus and other streptococci">
{{rx|Streptococcus anginosus and other streptococci}}
<li>[[Penicillin G]] 24 MU q4h</li>
* [[Penicillin G]] 24 MU q4h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Aspergillus" data-collapsetext="Aspergillus">
{{rx|Aspergillus}}
<li>[[Voriconazole]] 8 mg/kg/day q12h</li>
* [[Voriconazole]] 8 mg/kg/day q12h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Candida" data-collapsetext="Candida">
{{rx|Candida}}
<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h <u>OR</u> [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Cryptococcus neoformans" data-collapsetext="Cryptococcus neoformans">
{{rx|Cryptococcus neoformans}}
<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h <u>OR</u> [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Mucorales" data-collapsetext="Mucorales">
{{rx|Mucorales}}
<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h <u>OR</u> [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Pseudallescheria boydii (Scedosporium apiospermum)" data-collapsetext="Pseudallescheria boydii (Scedosporium apiospermum)">
{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
<li>[[Voriconazole]] 8 mg/kg/day q12h</li>
* [[Voriconazole]] 8 mg/kg/day q12h
</ul>
</li>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Toxoplasma gondii" data-collapsetext="Toxoplasma gondii">
{{rx|Toxoplasma gondii}}
<li>[[Sulfadiazine]] 4–6 g/day q6h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
* [[Sulfadiazine]] 4–6 g/day q6h {{and}} 
<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
* [[Pyrimethamine]] 25–100 mg/day qd
</ul>
</li>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Infectious disease]]
 
[[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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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

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