Template:ID-Epidural abscess: Difference between revisions

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* Spinal epidural abscess<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
*1. '''Spinal epidural abscess'''<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
:* '''Empiric antimicrobial therapy'''
:*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
::* 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 (1): Decompressive laminectomy in conjunction with long-term antibiotic therapy tailored to culture results is required.
::: Note (2): For critically ill patients, a vancomycin loading dose of 20–25 mg/kg may be considered.
::* Note (2): For critically ill patients, a loading dose of [[Vancomycin]] 20–25 mg/kg may be considered.


:* Pathogen-directed antimicrobial therapy
:*1.2 '''Pathogen-directed antimicrobial therapy'''
::* '''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


::* '''Methicillin-susceptible Staphylococcus aureus or Streptococcus'''
::*1.2.2 '''Methicillin-susceptible ''Staphylococcus aureus'' or ''Streptococcus'''''
:::* Preferred regimen: [[Cefazolin]] 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Nafcillin]] 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Oxacillin]] 2 g IV q4h 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  
 
:::* 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
:::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks


::* '''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
:::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
:::* 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.
:::* 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


::* '''Streptococcus'''
:::* Alternative regimen (3): [[Moxifloxacin]] 400 mg IV q24h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen: [[Penicillin G]] 3–4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Ampicillin]] 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks


::* '''Enterococcus'''
::*1.2.8 '''Anaerobes'''
:::* Preferred regimen: [[Penicillin G]] 3–4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Ampicillin]] 2 g IV q4h 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


::* '''Enterobacteriaceae'''
::*1.2.9 '''''Staphylococcus'', Gram-negative bacteria, and anaerobes (mixed infection)'''
:::* Preferred regimen: [[Ceftriaxone]] 1–2 g IV q12h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Cefotaxime]] 2 g IV q6–8h 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  


::* '''Gram-negative bacteria'''
:::* Preferred regimen (2): [[Ticarcillin-Clavulanate]] 3.1 g IV q4h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen:[[Ceftazidime]] 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Cefepime]] 2 g IV q12h for 2–4 weeks, then PO to complete 6–8 weeks
:::* Alternative regimen: [[Ciprofloxacin]] 400 mg IV q12h for 2–4 weeks, then PO to complete 6–8 weeks {{or]] [[Levofloxacin]] 750 mg IV q24h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Moxifloxacin]] 400 mg IV q24h for 2–4 weeks, then PO to complete 6–8 weeks


::* '''Anaerobes'''
:::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q4–6h 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
:::* Alternative regimen (1): [[Imipenem]] 500–1000 mg IV q6h for 2–4 weeks {{then}} PO to complete 6–8 weeks  


::* '''Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)'''
:::* Alternative regimen (2): [[Meropenem]] 1–2 g IV q8h for 2–4 weeks {{then}} PO to complete 6–8 weeks
:::* Preferred regimen: [[Ampicillin-Sulbactam]] 3 g IV q6h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q4–6h for 2–4 weeks, then PO to complete 6–8 weeks
:::* Alternative regimen: [[Imipenem]] 500–1000 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks {{or}} [[Meropenem]] 1–2 g IV q8h 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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